P35 CAUSES OF DEPRESSION / AUTISTIC SPECTRUM DISORDERS

In this chapter we will discuss the causes of a depression. This is an example of a condition / symptom which is normally treated with prescription drugs. Very seldom practitioner search for the actual causes.

Please keep in mind that depression can be a serious condition, which needs to in hands of a physician or a qualified health care professional. Nevertheless you as a coach can give lifestyle advice and guide the client to approach the right practitioners who address the cause of disease.

Depression

Depression is a common and serious illness that negatively affects how you feel, the way you think and how you act as described by the American Psychiatric Association.

An estimated 121 million people around the world currently suffer from some form of depression.

One in 16 young Australians is currently experiencing depression. This means: 6.3% of Australians aged 16 to 24 have experienced an affective disorder in the last 12 months.

This is equivalent to 180,000 young people today.

Depression is a condition that reportedly affects 1 in 10 Americans at one point or another. The number of patients diagnosed with depression increases by approximately 20% per year. Overall, women have higher rates of depression than men, most prevalent in ages between 45-64.

Depression Rating Scales

1. DASS

To evaluate your state of depression you can use the DASS a 42-item self report instrument designed to measure the three related negative emotional states of depression, anxiety and tension/stress.

The DASS questionnaire is public domain, and so permission is not needed to use it. The DASS questionnaires and scoring key may be downloaded from the DASS website and copied without restriction (go to http://www2.psy.unsw.edu.au/Groups/Dass/down.htm).

The Depression scale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/involvement, and inertia and is rated from normal, mild, moderate, severe to extremely severe.

The DASS may be administered and scored by you or non-psychologists, but decisions based on particular score profiles should be made only by experienced clinicians who have carried out an appropriate clinical examination.

2. Hamilton Depression Rating Scale

The Hamilton Depression Rating Scale (HAM-D) has proven useful for many years as a way of determining a patient’s level of depression before, during, and after treatment.

It should be administered by a clinician experienced in working with psychiatric

patients .

Although the HAM-D form lists 21 items, the scoring is based on the first 17. It

generally takes 15-20 minutes to complete the interview and score the results. Eight items are scored on a 5-point scale, ranging from 0 = not present to 4 = severe. Nine are scored from 0-2.

Since its development in 1960 by Dr. Max.Hamilton of the University of Leeds,

England, the scale has been widely used in clinical practice and become a standard in pharmaceutical trials.

Download the Hamilton Depression Rating Scale here:

http://www.assessmentpsychology.com/HAM-D.pdf

Depression comes with:

• Persistent sad, anxious, or “empty” feelings
• Feelings of guilt, worthlessness, helplessness or pessimism
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable, including sex
• Fatigue and decreased energy
• Difficulty concentrating, remembering details, and making decisions
• Insomnia, early-morning wakefulness, or excessive sleeping
• Overeating, or appetite loss
• Thoughts of suicide, suicide attempts
• Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

Currently most psychiatric treatment attempts to readjust the individual’s neurological biochemistry through pharmacology. These antidepressant drugs work on neurotransmitters mainly serotonin, noradrenalin and dopamine. While these drugs have a level of effectiveness and may be sufficient for some, they collectively fall short of addressing the problem and “overall health.”

Success rate of pharmacologic intervention for depression is a mere 50% or less.

Treatment-resistant depression: no panacea, many uncertainties. Adverse effects are a major factor in treatment choice. (2011). Prescrire International, 20(116), 128–33.

Popular and newest antidepressants are called selective serotonin reuptake inhibitors (SSRIs). For example: Prozac, Zoloft, Lexapro, Paxil and Celexa to name the most common ones. Tricyclic antidepressants (TCAs) are around for more than 50 years and not as effective as SSRIs. TCAs increase the amount of Serotonin and noradrenaline in the brain. Common brands are Endep, Anafril, Placil, Allegron, Dothep, Doxepin….

Side effects of antidepressants can be quite severe. Prozac and other SSRIs can cause nausea, loss of appetite, headache, nervousness, insomnia, restless leg syndrome and difficulties with libido and sexual dysfunction. The tricyclic antidepressants cause dry mouth, blurred vision, dry eyes, weight gain, high heart rate, problems urinating, slow rate of digestion (nausea, bloating), sexual problems, anxiety, insomnia, agitation, nausea…Additionally some drugs increase suicidal tendency.

Not only that antidepressant cause side effects they also cause withdrawal symptoms after discontinuation.  Symptoms range from: Dizziness, light-headedness, vertigo, shock-like sensations, paresthesias, fatigue, headache, nausea, tremor, diarrhea, and visual disturbances as well as psychological symptoms such as anxiety, insomnia, irritability and depression.

Fava, G. a, Gatti, A., Belaise, C., Guidi, J., & Offidani, E. (2015). Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: a systematic review. Psychotherapy and Psychosomatics, 84(2), 72–81. http://doi.org/10.1159/000370338

Nielsen, M., Hansen, E. H., & Gøtzsche, P. C. (2012). What is the difference between dependence and withdrawal reactions? A comparison of benzodiazepines and selective serotonin re-uptake inhibitors. Addiction, 107(5), 900–908. http://doi.org/10.1111/j.1360-0443.2011.03686.x

Dealing with depression should be always done with utmost of care. Suicide and self-harm is a great concern and if any signs are noticeable a referral to a medical practitioner is crucial.

Prescription drugs should be never stopped unless the patient is under supervision of a medical doctor.

Nevertheless an integrative approach targeting causative factors will help the patient to gain back his enjoyment for life.

General Diagnosis

The common knowledge is that depression comes from a chemical (neurotransmitter) imbalance. But this is a way to easy viewpoint as depression has many possible causes.

Sure neurotransmitters and other chemicals are most of the time involved in orchestrating billions of chemical reactions that make up the dynamic system that is responsible for our mood, perceptions and how we experience life.

According to the monoamine hypothesis, depression can be ascribed to deficits in the monoamine neurotransmitters: serotonin, dopamine, and noradrenaline. The evidence of this hypothesis has primarily emerged from the apparent success of drugs that increase the concentration of these neurotransmitters, especially serotonin, in the synaptic clefts throughout the brain.

New research understands that there is considerable potential in that theory but there are other factors, which influence our mood.

For example, over 80% of the individuals did not respond to the antidepressants. In addition, many studies that failed to support the efficacy of antidepressants have not been published. The effects that are observed tend to manifest after several weeks, even though changes in monoamines are almost immediate, again challenging the notion that monoamines directly affect mood.

Moerman, D. E. (2002). “The loaves and the fishes”: A comment on “The emperor’s new drugs: An analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration.” Prevention & Treatment, 5(1), 1–11. http://doi.org/10.1037/1522-3736.5.1.529c

Pigott, H. E. (2011). STAR*D: A Tale and Trail of Bias. Ethical Human Psychology and Psychiatry, 13(1), 6–27. http://doi.org/10.1891/1559-4343.13.1.6

“George Slavich, a clinical psychologist at the University of California in Los Angeles, has spent years studying depression, and has come to the conclusion that it has as much to do with the body as the mind. 

‘I don’t even talk about it as a psychiatric condition anymore,’ he says. ‘It does involve psychology, but it also involves equal parts of biology and physical health.’

The basis of this new view is blindingly obvious once it is pointed out: everyone feels miserable when they are ill. That feeling of being too tired, bored and fed up to move off the sofa and get on with life is known among psychologists as sickness behaviour. 

It happens for a good reason, helping us avoid doing more damage or spreading an infection any further. It also looks a lot like depression.”

COMPOUNDING CAUSES of DEPRESSION

1. Diet

Diet plays a significant role in mental well-being and overall health. Lack of proper nutrition, food allergies that present with psychiatric symptoms (such as depression and anxiety), food additives that some individuals are sensitive to, and an excess of junk food can negatively affect mood and behaviour, sometimes to a pathological level.

A study of 3,456 middle-aged civil servants, published in British Journal of Psychiatry found that those who had a diet which, contained a lot of processed foods had a 58% increased risk for depression, whereas those whose diet could be described as containing more whole foods had a 26% reduced risk for depression.

Akbaraly, N., Brunner, J., Ferrie, E., Marmot, G., Kivimaki, M., & Et al. (2009). Dietary pattern and depressive symptoms in middle age. British Journal of Psychiatry, 195, 408–413. http://doi.org/10.1192/bjp.bp.108.058925

Artificial food additives, especially the artificial sweetener aspartame, can wreak havoc with your brain function. Both depression and panic attacks are known potential side effects of aspartame consumption. Other additives, such as artificial colorings, are also known to impact mood.

2. Gut health

The gut microbiota are an important player in how the body influences the brain, contribute to normal healthy homeostasis, and influence risk of disease, including anxiety and mood disorders.

When we speak of the gut-brain axis we acknowledge the communication via nerves such as the Vagus nerve and similar nerve endings and chemicals that relay signals and neurotransmitters between the gut and the brain.

Gut bacteria play an essential role in the manufacture of neurotransmitters – such as 95% of the brain’s serotonin.

In an animal model experiment, Irish researchers found that mice lacking certain gut bacteria during infancy never developed normal serotonin levels, even when they were colonized with essential bacteria later in life.

The microbiome is a dynamic entity, influenced by several factors, including diet, metabolism, age, geography, antibiotic treatment, toxins, hormones and stress.

Certain strains of probiotics can increase the availability of tryptophan, the key precursor to making serotonin.

Gluten, a protein found in grains such as wheat, rye, and barley and casein, a protein found in milk may negatively impact mood and brain health.

Genetically engineered (GE) ingredients can significantly alter your gut flora, thereby promoting pathogens while decimating the beneficial microbes necessary for optimal mental and physical health.

Wang, Y., & Kasper, L. H. (2014). The role of microbiome in central nervous system disorders. Brain, Behavior, and Immunity, 38, 1–12. http://doi.org/10.1016/j.bbi.2013.12.015

Foster, J. a., & McVey Neufeld, K. A. (2013). Gut-brain axis: How the microbiome influences anxiety and depression. Trends in Neurosciences, 36(5), 305–312. http://doi.org/10.1016/j.tins.2013.01.005

Gastrointestinal inflammation also may be a significant contributing factor to depression. Food allergies can play a major role. It has been found, for example, that 25% of Irritable Bowel Syndrome patients, in whom GI inflammation is common, are sensitive to cow milk, wheat, egg, tomato, and chocolate. Symptoms improve on an elimination diet

Fehér, János; Kovács, Illés; Balacco Gabrieli, C. (2011). Role of gastrointestinal inflammations in the development and treatment of depression. Orvosi Hetilap, 152(37), 1477.

3. Inflammation

Inflammation is a main cause of depletion, exhaustion and excessive use of body resources. It deportees a body of all vital minerals and nutrients.

Physician Mark Hyman has written extensively about the ill effects of ingesting toxins and other substances that lead to inflammation. He found through his clinical experience and a review of the research that over time, these problems seem to contribute to depression, anxiety and mood swings.

Several studies support the role of inflammation and immune deregulation in depression. Elevated levels of inflammatory cytokines have been found in patients suffering depression. Cytokines are substances, which aid cell-to-cell communication in immune responses and stimulate the movement of cell towards the sites of inflammation, trauma and infection.

Some of the cytokines that escalate the immune response–such as interleukin 1, interleukin 6, and tumor necrosis factors–tend to increase depression.

The systemic inflammation marker C-reactive protein (CRP) is also associated with depression. CRP and inflammatory cytokines are involved in many undesirable disorders such as arthritis, cardiovascular disease, colitis, autoimmune disease, cancer, infections….This has lead researchers to identify depression as a late stage consequence of chronic inflammation.

Tsao, C.-W., Lin, Y.-S., Chen, C.-C., Bai, C.-H., & Wu, S.-R. (2006). Cytokines and serotonin transporter in patients with major depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 30(5), 899–905. http://doi.org/10.1016/j.pnpbp.2006.01.029

Cizza, G., Eskandari, F., Coyle, M., Krishnamurthy, P., Wright, E. C., Mistry, S., & Csako, G. (2009). Plasma CRP levels in premenopausal women with major depression: A 12-month controlled study. Hormone and Metabolic Research, 41(8), 641–648. http://doi.org/10.1055/s-0029-1220717

4. Nutritional Deficiencies

Nutritional deficiencies can be caused by mal-absorption due to inflammation, lack of proteolytic enzymes (pancreatic problems), Cholecystectomy, low bile salt production, liver congestion, low hydrochloric acid production, leaky gut, inflammation, stress, food sensitivities, low intrinsic factor …..

Deficiencies are also caused by heavy metal toxicity, excess sugar, diabetic conditions and food sensitivities due to increased demand.  All these causes need to be addressed if mal-absorption is a problem.

From a nutritional perspective the parent molecules for neurotransmitter synthesis are the amino acids L-Tryptophan and L-Phenylalanine. Both pathways require several cofactors. Tryptophan is the direct precursor for serotonin synthesis and L-Phenylalanine is the direct precursor for dopamine, noradrenaline and adrenaline synthesis. A cofactor deficiency in these pathways can directly lead to depression. (See flowchart below)

Nutrients always play a multifunctional role and deficiencies are evident in many different pathways and body functions.

a.) Magnesium

A deficiency in this essential major mineral has been known to lead to irritability, fatigue, anxiety and depression. It leads an important role in blood sugar balance, the production of omega-3 fatty acids, nervous system function and many more. See magnesium chapter essential nutrients)

Serefko, A., Szopa, A., Wlaź, P., Nowak, G., Radziwoń-Zaleska, M., Skalski, M., & Poleszak, E. (2013). Magnesium in depression. Pharmacological Reports, 65(3), 547–54. http://doi.org/10.1016/s1734-1140(13)71032-6

Derom, M.-L., Sayón-Orea, C., Martínez-Ortega, J. M., & Martínez-González, M. a. (2013). Magnesium and depression: a systematic review. Nutritional Neuroscience, 16(5), 191–206. http://doi.org/10.1179/1476830512Y.0000000044

b.) Iodine

Iodine deficiency is linked to insulin resistance and depression. Iodine increases insulin sensitivity and by default increases the uptake of tryptophan and its subsequent conversion to serotonin.

c.) Zinc

In addition to aiding the immune system and keeping memory sharp, zinc is required in the production and use of neurotransmitter.  A 2009 study found people who hadn’t been helped by antidepressants in the past finally reported improvements once they started zinc supplementation.

Siwek, M., Dudek, D., Paul, I. a., Sowa-Kućma, M., Zieba, A., Popik, P., … Nowak, G. (2009). Zinc supplementation augments efficacy of imipramine in treatment resistant patients: A double blind, placebo-controlled study. Journal of Affective Disorders, 118(1-3), 187–195. http://doi.org/10.1016/j.jad.2009.02.014

Lai, J., Moxey, A., Nowak, G., Vashum, K., Bailey, K., & McEvoy, M. (2012). The efficacy of zinc supplementation in depression: Systematic review of randomised controlled trials. Journal of Affective Disorders, 136(1-2), e31–e39. http://doi.org/10.1016/j.jad.2011.06.022

d.) Vitamin D

“A systematic review and meta-analysis of 14 studies with a total of 31,424 participants revealed an association between vitamin D levels and depression,” said a summary of the study, from researchers at the Department of Psychiatry and Behavioral Neurosciences, St Joseph’s Hospital, Hamilton, Ontario, Canada.

Li, G., Mbuagbaw, L., Samaan, Z., Zhang, S., Adachi, J. D., Papaioannou, A., & Thabane, L. (2013). Efficacy of vitamin D supplementation in depression in adults: a systematic review protocol. Systematic Reviews, 2(1), 64. http://doi.org/10.1186/2046-4053-2-64

e.) Vitamin C

Vitamin C is important for the metabolism of essential fatty acids. It also strengthens the adrenals and other endocrine glands. It is needed to synthesize the neurotransmitters noradrenaline and dopamine.

Gariballa, S. (2014). Poor Vitamin C Status is Associated with Increased Depression Symptoms Following Acute Illness in Older People. International Journal for Vitamin and Nutrition Research, 84(1-2), 12–17. http://doi.org/10.1024/0300-9831/a000188

f.) Vitamin B complex

Vitamin B’s have the most dramatic mood elevating effects than all other nutrients.

Vitamin B1, Thiamine is required for brain cells to produce energy. A deficiency can impair mental function.

Vitamin B2, Riboflavin improves energy production in certain brain cells, is necessary for fatty acid production and helps to recycle glutathione.

Vitamin B3, Niacin may have an indirect effect on serotonin levels, because the body uses tryptophan to produce niacin and on adrenal hormones. Symptoms of a long-term deficiency in niacin are Psychosis and dementia.

Vitamin B6, Pyridoxine can help correct brain metabolism dysfunctions that cause depression.  It acts as a cofactor for enzymes that convert tryptophan to serotonin as well as tyrosine to noradrenaline.

Hvas, A.-M., Juul, S., Bech, P., & Nexø, E. (2004). Vitamin B6 level is associated with symptoms of depression. Psychotherapy and Psychosomatics, 73, 340–343. http://doi.org/10.1159/000080386

A deficiency from B12 causes neurological problems and confusion, depression and memory loss.

B12 and folate work closely together to regulate functions relating to mood. Both help stimulate the formation of a compound necessary for the first step in synthesizing neurotransmitters, especially serotonin.  A folic acid deficiency can lower brain levels of serotonin and S-adenosyl-methionine (SAMe), the amino acid metabolite with mood elevating properties.

Bottiglieri, T. (2005). Homocysteine and folate metabolism in depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 29(7), 1103–1112. http://doi.org/10.1016/j.pnpbp.2005.06.021

Dimopoulos, N., Piperi, C., Salonicioti, A., Psarra, V., Gazi, F., Papadimitriou, A., … Kalofoutis, A. (2007). Correlation of folate, vitamin B12 and homocysteine plasma levels with depression in an elderly Greek population. Clinical Biochemistry, 40(9-10), 604–8. http://doi.org/10.1016/j.clinbiochem.2007.01.007

Inositol also known as Vitamin B8, has been reported to be effective for the treatment of depressed patients. Inositol is a constituent of the intracellular phosphatidyl inositol second messenger system, which is linked to various neurotransmitter receptors, such as serotonin, dopamine, and glutamate receptor, thereby altering brain neurotransmitters including serotonin level.

Sachs, G. S., Lafer, B., Stoll, a. L., Banov, M., Thibault, a. B., Tohen, M., & Rosenbaum, J. F. (1994). A double-blind trial of bupropion versus desipramine for bipolar depression. Journal of Clinical Psychiatry, 55(9), 391–393. http://doi.org/10.1002/hup

Levine, J., Barak, Y., Gonzalves, M., Szor, H., Elizur, A., Kofman, O., & Belmaker, R. H. (1995). Double-blind, controlled trial of inositol treatment of depression. The American Journal of Psychiatry, 152(5), 792–4. http://doi.org/10.1176/ajp.152.5.792

g.) Coenzyme Q10 (CoQ10)

CoQ10 plays a major role in overall metabolism, heart health and immune function. In particular it acts as a catalyst for the process by which the body produces ATP, necessary for energy at the cellular level. Deficiency symptoms include fatigue, mental lethargy and depression.

CoQ10 is especially very low with statin drug users.

Maes, Michael; Mihaylova, Ivanka; Kubera, Marta; Uytterhoeven, Marc; Vrydags, Nicolas; Bosmans, E. (2009). Lower plasma Coenzyme Q10 in depression: A marker for treatment resistance and chronic fatigue in depression and a risk factor to cardiovascular disorder in that illness. Neuroendocrinology Letters, 30(4), 462–469.

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h.) Amino acids

Amino acids are the building blocks of protein. Recent scientific studies have demonstrated conclusively that bodily levels of a half-dozen major amino acids can increase or decrease the bodies supply of neurotransmitters, thus altering mood, sleeping patterns, immunity, and other bodily functions. Amino acids are successfully used to treat insomnia, relieving anxiety and depression.

Amino Acid	Neurotransmitter Affected	Predominate Action	Conditions Treated
5-HTP	Serotonin	Calming	Depression, anxiety, insomnia
L-Phenylalanine	Dopamine, Noradrenaline	Stimulating	Depression, fatigue, lack of pleasure
Tyrosine	Dopamine, Noradrenaline	Stimulating	Depression, fatigue, lack of pleasure
Glutamine	Glutamine	Stimulating	Depression, fatigue
GABA	GABA	calming	Depression, anxiety
SAM	Serotonin	Stimulating	Depression

Caution: 

The treatment of depression belongs into the hand of a qualified, registered health professional.  For example: prescribing someone 5-HTP who is already on SSRI or any other antidepressant drug can be very dangerous due to excessively high serotonin levels.

i.) Essential fatty acids- Omega3

Our brain consists of a very high concentration, around half of the weight of the brain, of essential fatty acids and other fats. That’s why fatty acids have an effect on mind and mood. Cells that are weakened by a deficiency of the right fats are unable to process serotonin and other neurotransmitters, which may result in adverse effects on mood and behaviour.

As a side note: People who had a Cholecystectomy and are not on fat digestive enzymes (Lipase) and bile salts can develop mood disorders and depression.

DHA a Omega 3 fatty acid is the most prominent fatty acid in the brain and deficiency is linked to post-pregnancy depression, Alzheimer, dementia, ADHD, depression and other mood disorders, reduced concentration, memory loss and hostility.

Meyer, B. J., Grenyer, B. F. S., Crowe, T., Owen, A. J., Grigonis-Deane, E. M., & Howe, P. R. C. (2013). Improvement of Major Depression is Associated with Increased Erythrocyte DHA. Lipids, 48(9), 863–868. http://doi.org/10.1007/s11745-013-3801-7

Pomponi, M., Loria, G., Salvati, S., Di Biase, a, Conte, G., Villella, C., … Bentivoglio, a R. (2014). DHA effects in Parkinson disease depression. Basal Ganglia, 4(2), 61–66. http://doi.org/10.1016/j.baga.2014.03.004

j.) Low cholesterol

Cholesterol helps in the synthesis of various hormones, including a number that may play a crucial role in mood regulation. Cholesterol also promotes the absorption of fatty acids.

Low cholesterol defined as 160 mg/dL (4.5 mmol/liter) or lower are linked to depression and even suicide.

Partonen, T., Haukka, J., Virtamo, J., Taylor, P. R., & Lonnqvist, J. (1999). Association of low serum total cholesterol with major depression and suicide. The British Journal of Psychiatry, 175, 259–262. http://doi.org/10.1192/bjp.175.3.259

5.  Hormonal Imbalances (Oestrogen, thyroid, adrenal hormones)

Given that nearly 10% of the population has hypothyroidism and that this condition, due to its mental and behavioural manifestations, is overrepresented amongst psychiatric patients, the diagnosis of subclinical or clinical hypothyroidism must be considered in every patient with depression.

Depression seems to be more common in people with hypothyroidism.  The authors of one study concluded that depressed patients should be screened for hypothyroidism, and in these patients, depression may be more responsive to a replacement regimen that includes T3 rather than T4 alone.

Another study looked at the relationship between thyroid-stimulating hormone levels (TSH) and the risk of depression. It concludes that suboptimal thyroid function increases vulnerability to the occurrence of depressive symptom and represents a modifiable risk factor for depression in females.

Rack, S. K., & Makela, E. H. (2000). Hypothyroidism and Depression: A Therapeutic Challenge, 34, 1142–1145.

Kim, E. Y., Kim, S. H., Rhee, S. J., Huh, I., Ha, K., Kim, J., … Ahn, Y. M. (2015). Relationship between thyroid-stimulating hormone levels and risk of depression among the general population with normal free T4 levels. Psychoneuroendocrinology, 58, 114–119. http://doi.org/10.1016/j.psyneuen.2015.04.016

Stress with high cortisol and DHEA have been associated with anxiety and depression. People going through adrenal fatigue with low cortisol/DHEA can also suffer from depression, loss of interest in life, brain fog and difficulty concentrating. Decreased stamina and pronounced morning fatigue may be a clue that there could be a low adrenal function component contributing to depression.

Sex hormones and neurotransmitters share common pathways and receptor sites in areas of the brain linked to mood, particularly through the hypothalamic-pituitary-gonadal axis. Women who experience episodes of depression are quite often associated with reproductive events (i.e., premenstrual, postpartum, menopausal transition) due to a heightened sensitivity to intense hormonal fluctuations. The menopausal transition, for example, appears to represent a window during which some women might be more vulnerable to the development of first onset or recurrent depressive symptoms and major depressive episodes.

Soares, C. N., & Zitek, B. (2008). Reproductive hormone sensitivity and risk for depression across the female life cycle: A continuum of vulnerability? Journal of Psychiatry and Neuroscience, 33(4), 331–343.

6. Melatonin deficiency

Melatonin is often called the ‘hormone of darkness’ as it is exclusively involved in signaling the ‘time of day’ to all tissues and is thus considered to be the body’s chronological pacemaker. Melatonin participates in diverse physiological functions. (more under natural anti- cancer treatments)

People with Seasonal Affective Disorder who regularly suffer from depression may have a diminished release of melatonin during the night due lack of daytime light in winter months.

Chronic stress decreases the ability of the pineal gland to make melatonin, which has potential adverse effects on mood.

Pandi-Perumal, S. R., Srinivasan, V., Maestroni, G. J. M., Cardinali, D. P., Poeggeler, B., & Hardeland, R. (2006). Melatonin. FEBS Journal, 273(13), 2813–2838. http://doi.org/10.1111/j.1742-4658.2006.05322.x

7. Congested liver ; liver disease

There’s an old saying in China: “If you’re depressed, blame the liver.” Chinese medicine believes there is a direct correlation between liver function and depression. The emotional state is seriously affected by the Liver’s function of “Flowing and Spreading” Qi. When it flows normally, emotions are approximate and easy. When the spreading of Qi impaired or the circulation of Qi restrained, there will be emotional depression, frustration, repressed anger, and physical symptoms.

A research, carried out by scientists at the University of Edinburgh, took account for obvious sociological and physiological factors such as alcohol consumption, obesity, diabetes and class, but still the data pointed to a clear relationship between the psychological conditions of stress and depression and the physical health of the hepatic system.

Russ, T. C., Kivimäki, M., Morling, J. R., Starr, J. M., Stamatakis, E., & Batty, G. D. (2015). Association Between Psychological Distress and Liver Disease Mortality: a Meta-analysis of Individual Study Participants. Gastroenterology, 148(5), 958–966.e4. http://doi.org/10.1053/j.gastro.2015.02.004

Le Strat, Y., Le Foll, B., & Dubertret, C. (2015). Major depression and suicide attempts in patients with liver disease in the United States. Liver International : Official Journal of the International Association for the Study of the Liver, 35(7), 1910–6. http://doi.org/10.1111/liv.12612

8.  Blood sugar problems

Hypoglycaemia a condition of low blood sugar levels, which can lead to depression. Blood sugar, in the form of glucose, is the basic fuel for all brain operation and physical activity, including muscular. If the available fuel is too inadequate, any marginal physical or mental system may start to shut down.

Low blood sugar can be the result of a high sugar diet and insulin resistance where the body’s cells become less sensitive to the effects of insulin. After ingesting excess sugar the body responses with an excessive output of insulin to break down the high sugar intake. Around 2 hours later all sugar is stored and used and the blood sugar level reaches a low sugar level due to the excess of insulin. These hypoglycaemic condition can happen several times a day and therefore leading to symptoms such as nervousness, anxiety, irritability, depression, inability to concentrate to name a few.

The typical response of a person experiencing these symptoms is to eat another high sugary food or meal and the vicious cycle unfolds. This eventually leads to the development of Type 2 Diabetes.

Chromium plays a role in normal insulin function. Eating too many carbohydrates will deplete the body’s store of chromium. A study reported improved mood in clinical depressives and diabetics after receiving the insulin- sensitizing nutrient chromium picolinate.

McCarty, M. (1994). Enhancing central and peripheral insulin activity as a strategy for the treatment of endogenous depression–an adjuvant role for chromium picolinate? Medical Hypotheses, 43(4), 247–252.

Davidson, J. R. T., Abraham, K., Connor, K. M., & McLeod, M. N. (2003). Effectiveness of chromium in atypical depression: A placebo-controlled trial. Biological Psychiatry, 53(3), 261–264. http://doi.org/10.1016/S0006-3223(02)01500-7

“A high association between type 2 diabetes mellitus and depressive illness has been reported. Insulin resistance during depressive illness might contribute to the linkage between depression and type 2 diabetes.”

Chiba, M., Suzuki, S., Hinokio, Y., Hirai, M., Satoh, Y., Tashiro, a, … Toyota, T. (2000). Tyrosine hydroxylase gene microsatellite polymorphism associated with insulin resistance in depressive disorder. Metabolism Clinical and Experimental, 49(9), 1145–1149. http://doi.org/10.1053/meta.2000.8611

9. Toxins

Toxic metals such as mercury, lead, cadmium or arsenic in the brain can cause the following symptoms: weakening of the blood –brain barrier, altered neurotransmitter levels, destruction or demyelination of the myelin sheath, increased oxidative stress and destruction of glutathione and other protective proteins.

It is no wonder that a toxic metal overload can cause clinical depression.

Circulating toxins from food additives if not detoxified by the liver can also enter the brain and create havoc. The brain has the ability to detoxify through methylation and sulphation pathways but if these pathways are down regulated or saturated then we may see problems.

Glyphosate, the most widely used herbicide on food crops in the world, has been shown to cause nutritional deficiencies, especially minerals, which are critical for brain function and mood control.

According to Thomas Benjamin, president of the Environmental Alliance for Senior Involvement, “Areas with serious air pollution problems … may cause stress, anxiety, and depression in addition to physical problems”–particularly for the elderly, children or those with weakened immune systems.

Dr. Doris Rapp, author of “Our Toxic World: A Wake-Up Call”, warns that “Environmental illness can be every bit as real as that caused by germs … and can trigger serious physical, neurological, and psychological problems.” She says symptoms of environmental illness can include “increased fatigue, moodiness, depression, irritability, hyperactivity, aggression, and an inability to focus and remember.”

Solvents, including those found in detergents, dry-cleaning fluids, perfumes, polystyrene cups, plates and packaging, synthetic rubber, some cosmetics and cleaning supplies, have been linked to neurological disorders including depression.

10. Methylation / MTHFR impairment

DNA methylation in an organism profoundly affects numerous aspects of physiology, including prenatal development, growth, metabolic levels, ATP (energy) production, neurotransmitter levels, metabolism of heavy metals, and susceptibility to cancer. It is critical to the metabolism of catecholamine’s in the synapse via an enzyme (COMT) as well as the synthesis of ‘depression-relevant’ compounds such as melatonin, myelin basic protein, carnitine, CoQ10, etc. Methylation is required to inactivate histamine.

Problems with the methylation cycle may also be related to autism, mental illness such as depression, food allergies, asthma, and the development of heart disease.

Methylation can be supported by adequate magnesium, Vitamin B12 (methylcobolamin) folic acid and activated B6, or by supplementing TMG (Trimethylglycine), which are B12/folic acid independent methylation pathways.

SAMe (activated methionine) directly donates methyl groups (methyl groups turn on serotonin and thus melatonin production) and therefore works as an antidepressant.

MTHFR polymorphism can alter function of the methylation cycle. The MTHFR SNP acts by reducing the function of the methylation cycle-specifically reducing the conversion of 5,10 methyl-tetrahydrofolate to 5-methyltetrahydrofolate. This reduces the synthesis of methionine, results in increased homocysteine and altered DNA methylation. The odds of having depression were 36% greater if a person had two copies of the MTHFR SNP.

Gilbody, S., Lewis, S., & Lightfoot, T. (2006). Methylenetetrahydrofolate Reductase (MTHFR) Genetic Polymorphisms and Psychiatric Disorders: A HuGE Review. American Journal of Epidemiology, 165(1), 1–13. http://doi.org/10.1093/aje/kwj347

11. Stress

The body responds to stress (mental or physical) via the hypothalamic-pituitary-adrenal axis. For example, if you are enjoying your walk in the park and a tiger jumps in front of you, your “fight or flight” system is fired into full gear, your heart pounds, your pupils dilate, your hair stands on end, natural steroids and adrenaline flood your system to strengthen your muscles and give you an extra burst of speed. Even your platelets change shape so they are stickier, leaving you less likely to bleed out if you are attacked.

Naturally, our bodies have negative feedback that can tone down the fight or flight response once the danger is past. Under conditions of chronic stress, however, mental or physical, the feedback tends to get messed up, leading to symptoms of chronic stress, which includes mental issues such as anxiety or clinical depression.

When stress is elevated, corticotropin releasing hormone increases the production of interleukin 1, interleukin 6, tumor necrosis factors, and other cytokines. In addition, when stress is elevated, cortisol can evoke a range of reactions that may provoke depression. These accounts imply the association between cytokines (inflammation) and depression.

Various studies have related excessive amounts of the stress hormones to causing depression or aggravating existing depression. Cortisol secretion in depressed people is often higher than normal. When synthetic corticosteroid drugs are administered to nondepressed persons (for example to relieve inflammation in rheumatoid arthritis) depression, anxiety and sleeping problems are common side effects.

12. Prescription Drugs

Some commonly prescribed drugs can actually lead to depression, including some in these drug classes:

• Barbituates
• Tranquilizers & sleeping pills
• Heart Drugs with reserpine
• Beta-blockers
• High blood pressure drugs
• Ulcer drugs
• Anticonvulsants
• Anti-Parkinson drugs
• Some painkillers
• Contraceptive pills

Antibiotics and drugs containing cortisone destroy the natural balance of intestinal flora. The most common complaints of people suffering dysbiosis are depression and fatigue.

13. Exercise

A research on exercise and mental health concluded that exercise appears to have the most impact on people with mild to moderate anxiety and depression.

An interesting finding in the literature reveals that all types of exercise seem to have a positive effect on depression and other mental illness: aerobic, anaerobic and flexibility.

Special care needs to be taken with excessive physical activity as it may lead to overtraining and generate psychological symptoms that mimic depression.

Paluska, S. A., & Schwenk, T. L. (2000). Physical activity and mental health: current concepts. Sports Medicine (Auckland, N.Z.), 29(3), 167–80. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10739267

14. Lack of sleep

Essential sleep restores all of the major mind-body systems, including the ability to relax, release stress, and regulate emotions.

Depression is identified as the most frequent cause of insomnia and vice versa sleep problems often appear prior to the onset of a new or recurrent episode of depression.

Franzen, P. L., & Buysse, D. J. (2008). Sleep disturbances and depression: Risk relationships for subsequent depression and therapeutic implications. Dialogues in Clinical Neuroscience, 10(4), 473–481.

 

15. Green space

Consciously engaging with any kind of green space whether it is an own garden, a park, mountain, or meadow is a simple way to release stress and anxiety and connect with something larger. Spending time outside in nature is associated with significantly lower levels of symptomology for depression, anxiety and stress.

A review of people doing exercise amongst outdoor greenery such as walks and gardening found that 94% of respondents felt it improved their mental health and 71% reported decreased depression.

Beyer, K., Kaltenbach, A., Szabo, A., Bogar, S., Nieto, F., & Malecki, K. (2014). Exposure to Neighborhood Green Space and Mental Health: Evidence from the Survey of the Health of Wisconsin. International Journal of Environmental Research and Public Health, 11(3), 3453–3472. http://doi.org/10.3390/ijerph110303453

Mind. (2007). Ecotherapy – the green agenda for mental health Key findings Green exercise at local Mind groups. Retrieved from http://www.mind.org.uk/campaigns_and_issues/report_and_resources/835_ecotherapy

16. Allergies

Allergies can affect any or multiple systems of the body, including digestive, respiratory, cardiovascular, endocrine, and neurological. Al
lergic responses differ considerably amongst individuals. The same substance—latex, for example—that can cause one person to break out in hives can cause a different individual to have a panic attack. An individual can have allergies and not know it. Symptoms may not be as recognizable as those of allergic rhinitis, with sniffling and sneezing.

Psychiatric symptoms, in particular, even when they are of strictly physiological origin, may be mistakenly assigned to life situations, stress, or other causes. Although the most common allergy-related psychiatric symptoms that have been studied are depression and anxiety, given the variability of human response to allergies, any psychiatric symptom, including psychosis, has the potential of being allergy-induced.

For example, a person sensitive to mold who lives in an area that had recent flooding may respond with chronic depression for months if mold spores or mycotoxins are continuously present. Mold can also exist for years in locations such as heating, ventilation, and air conditioning systems, causing continuous exposure at home or work.

Shenassa, E. D., Daskalakis, C., Liebhaber, A., Braubach, M., & Brown, M. (2007). Dampness and mold in the home and depression: an examination of mold-related illness and perceived control of one’s home as possible depression pathways. American Journal of Public Health, 97(10), 1893–9. http://doi.org/10.2105/AJPH.2006.093773

Dealing with depression should be always done with utmost of care. Suicide and self-harm is a great concern and if any signs are noticeable a referral to a medical practitioner is crucial. 

Prescription drugs should be never stopped unless the patient is under supervision of a medical doctor.

Nevertheless an integrative approach targeting causative factors will help the patient to gain back his enjoyment for life.