Depression

We often say we are depressed but clinical depression is more than a feeling of sadness; it is a prolonged experience of the pointlessness of one’s life combined with a feeling of powerlessness to do anything about it. Depression can be in response to something happening, loss of a relationship in death or separation; loss of a job; or it can have no apparent cause. Some believe that depression in response to a life event is a natural reaction and should be recognised and understood and allowed to resolve naturally. We have tended to inhabit a world that does not tolerate these changes in mood and so frequently turn to a group of drugs called antidepressants. These drugs work by blocking enzyme pathways but do not take in to consideration that we may be overwhelmed by loss, or having to make considerable adjustments to our lives or way of thinking. The fact that drugs affect mood demonstrates that mood has a biological component, that mood is controlled by the levels and actions of the various chemicals produced by the nerve cells. We have 3 groups of nerve chemicals:

  1. Those that control all bodily functions by controlling the connection between the nerve and the muscle, the nerve and the gland. This control varies according to whether we are in a state of stress or calm; the first is controlled by the Sympathetic Nervous system, the latter by the Parasympathetic Nervous system. These two systems have an evolutional basis so that we can react to physical threat; but have developed so that we now react to threat much more at an emotional level .
  2. Those that control the amount of information that enters the nerve, its ability to be stimulated.
  3. Those that block stimulation.

It can be seen from these 3 groups that alterations in mood and brain activity can be accounted for easily by alterations in the levels of any of these chemicals, or in alterations in the receptive nature of the nerve to the chemical. This is why, drugs that in some way alter the levels, or inhibit or enhance their reaction, work. It is also why drugs have side effects.

However, there is another way of altering mood, which is much more natural; that is to balance the various chemicals so that each is able to play its effective part. We make everything of the body from what we digest, absorb, and use from what we eat. So that if a specific chemical is low, then it suggests a specific nutrient which is an essential component of the chemical, is also low. If a chemical is high, it is probably because it is not being broken down quickly enough, or completely enough to enable it to be excreted. It is by balancing what chemicals are made, and the rate of breakdown and excretion, that creates the balance of the various chemicals that control both the physical action and the mood. In depression it is recognised that the levels of Serotonin, and Dopamine are low, which is why most doctors prescribe a variety of drugs that increases the amount of these chemicals remaining at the site of action. None of these drugs increase the amount produced.

Serotonin and dopamine are part of a group of chemicals called neuro- transmitters; they carry the impulse from one nerve to another or from a nerve to a gland, nerve to a muscle. They are part of Group 1 listed above. A nerve when stimulated produces an electrical impulse which travels along the nerve but it cannot cross over the tiny space between one nerve and the next, or between the nerve and gland, or nerve and muscle. It is the various chemicals that flow across this space; each chemical has different functions, producing different effects in various parts of the body. Serotonin elevates mood, increases gut motility, and inhibits the action of noradrenalin to name some of them. Dopamine creates a feeling of wellbeing and reward, aids learning new material and memory. This is why there are a collection of symptoms other than changes in mood that are experienced when serotonin and dopamine levels are low. When the serotonin has stimulated the next cell any left-over is either taken back up into the cell that made it for use again next time, or broken down and excreted. The drugs work by preventing either one of these from happening, they do not increase the actual amount made.

Increasing the overall amount made is the aim of the way that I work. We make everything from the nutrients we absorb and can use from the food that we eat. If there is too little of any body chemical it suggests immediately to me that the body is short of one or more of the nutrients required to make it. I liken myself to a baker, I look at the list of ingredients in the recipe of an individual body chemical, and using a method called Functional Biochemistry to identify which of those ingredients is missing and will, therefore, put the problem right.

Serotonin is made from the amino acid tryptophan and converted into serotonin by the action of two enzymes. The first enzyme uses activated vitamin B2, B3, B6, and Folic Acid, and the mineral iron. It cannot use the vitamin in the form found in food, the body has to modify each of the vitamin B group first. To find out more about activation of vitamins I suggest you read the section on Functional Biochemistry. To activate vitamin B2 the body needs the vitamin riboflavin, and the minerals iodine and molybdenum. To activate vitamin B3 the body needs the vitamin niacin, and the minerals magnesium and zinc. To activate vitamin B6 the body needs the vitamin pyridoxal, and activated vitamin B2, and the minerals magnesium and zinc. To activate Folic Acid we need the vitamin plus activated vitamin B2, B3, B6, and activated vitamin B12. Using all these ingredients the body converts Tryptophan into 5 Hydroxytryptophan (5HTP). 5HTP is not active, it is simply an intermediate stage which is in turn converted by an enzyme into serotonin. The second enzyme requires activated vitamin B6 plus the minerals zinc and magnesium. I have included all this because some of you may have heard that taking 5HTP will help depression. I hope you can see that it may help some individuals but not all because if the problem lies in a deficiency of activated vitamin B6, magnesium or zinc then the second enzyme is unlikely to work and the 5HTP will not be converted into serotonin. As zinc is essential in 250 known enzyme reactions, and magnesium in 300, then to not treat these deficiencies will leave a great number of chemical reactions in the body under working. In fact some of the symptoms that frequently accompany depression will be accounted for by these deficiencies: lack of energy, extreme tiredness, difficulty in sleeping, palpitations, indigestion, and they will all remain unless the mineral deficiencies are corrected.

Dopamine is made from the amino acid tyrosine but uses the same two enzymes which require exactly the same nutrients to convert tyrosine first to L.Dopa and then L.Dopa to dopamine. This is why a deficiency of serotonin  is nearly always accompanied by a deficiency of dopamine.

Anxiety is a frequent accompaniment of depression for 2 reasons. Firstly, when anxiety is caused by raised levels of noradrenalin that stimulation of the Sympathetic Nervous System to trigger fight or flight, the action of noradrenalin is increased when the levels of serotonin are low. Equally noradrenalin requires many nutrients to break it down and these include zinc and magnesium as well as sulphur activated vitamin B12 and Folic Acid. Any deficiencies of these nutrients will decrease the breakdown of noradrenalin leaving it hanging around to re-stimulate the fight or flight mechanism. The other two groups of brain chemicals, listed at the beginning, also have a role to play in anxiety; and reduced levels of serotonin also impact them, but that is another subject. If anxiety is a particular feature for you then find it under the list of conditions.

Case study 1 – Jo

I was asked to see Jo by her husband. Jo was experiencing her 2nd episode of depression; the first following the birth of their only child some years before.

I went to see Jo at home because her depression made her unable to come to me. She was in her nighty and dressing gown despite it being 2pm, her hair was unbrushed yet I had been told that she normally cared a great deal about her appearance. She was sitting in the living room which was untidy doing nothing. She spoke at length about her feelings of despair, bleakness, guilt and anxiety; going round and round moving from one thought to the next. She was worried about her son because she was not caring for him, she was worried about her husband trying to manage the family business, shopping, cooking, cleaning, and child care. She was worried that the business was already not bringing in enough money and without her ability to do the normal household tasks it would fail even more. She perpetually worried about the state of the house, she felt guilty because all of this was because of her but she was unable to  anything about it. She was unable to go to sleep but then didn’t want to get up in the morning, she was eating very little with no appetite and constipated. She complained of palpitations which frightened her. In fact she was very fearful that she had a life threatening disease most likely cancer.

I found that both serotonin and dopamine levels were low, and noradrenalin was high. Melatonin, the chemical that induces sleep, was also low; which isn’t really surprising as its made from serotonin. I found that she was not activating enough vitamin B6, her levels were very low. She was very deficient in both zinc and magnesium. This meant that the replacement dose of both supplements zinc and magnesium was high. Discussions amongst the various family members raised husband’s anxieties about giving the large dose of supplements that I had found Jo needed; and preferred to give Jo the antidepressant prescribed by the doctor. Jo herself was reluctant to take the antidepressant having had a bad experience of them last time, she also wanted a more natural solution to her problems; however, her depression was so deep that she was not able to instigate very much in her life, which left the decision to her husband. He was giving her the antidepressant and a small dose of the supplements. I carried on visiting because Jo wanted me to and watched her condition deteriorate over the ensuing weeks till she was totally confined to bed. She was only eating if fed and would only have small sips of water when pressed. Under these circumstances her husband decided to try the larger dose of supplements and she gradually improved; it was a slow process taking several weeks but at the end I had a phone call from the husband thanking me for giving him the wife he never had. She was more fun, more dynamic, more relaxed than he had ever known her.

Why do I think she had the first episode after the birth of their child and why again all these years later? Most would say that puerperal depression (depression after childbirth) is caused by the enormous chemical and emotional change. This is of course true, truer than most people realise; because the body has to make all these chemicals to sustain the pregnancy at the same time as grow the baby. The baby is a parasite, albeit a welcome and much loved parasite, but it takes what it needs without hesitation, without thought of the mothers nutritional state or wellbeing. Following this she then has to make more chemicals to initiate the birth process, to bring in the milk and make the milk. She then has to breakdown all those chemicals as they become obsolete. All this takes nutrients. On top of this there is the stress of the labour, and stress is the biggest user of nutrients that there is. Most mothers experience the third day blues as the hormones take a big dive, but most do not go on to develop full blown depression. Of course the emotions play a part, the mother’s excitement, fear, worries about her ability to cope. These all add to the stress and the use of a greater amount of nutrients until the levels become too low to provide sufficient levels of the neuro-transmitter substances of serotonin and dopamine and she plunged into depression. Gradually she would have made up some of the deficiency, so that she was not actually depressed.

In the second instance the family business was not doing too well so that the worries about the finances were genuine. I suspect it was the stress of this that tipped the balance of an already deficient body. The husband’s comments tell us that she actually suffered from this deficiency all the time that he had known her; only when the deficiency was remedied was she able to show her true personality.

Last time I heard of Jo she was working full time and well; I do hope that she is remembering to take some extra zinc and magnesium. It won’t be in those high doses that she needed initially, just a small maintenance dose to compensate for the lack in the diet and for her own body’s particular need.

Case study 2 – Monica

Monica suffers with depression and anxiety for which she has had hospital admissions in the past. She had taken a variety of antidepressants and tranquilisers for years.  In fact had spent many years weaning herself from valium.

I found serotonin and dopamine were low and, just as with Jo, noradrenalin was high. However, despite taking supplements so that the brain chemistry is balanced Monica is not better. Have I missed something, are there chemicals that I know nothing about that I have not balanced. Despite no apparent deficiencies of all the known nutrients Monica is not well.

My feeling is that Monica has been ill for so long that she does not know how to be well. The brain is made up of nerve pathways as well as chemicals and the more we use a pathway the more we bed it in and the more entrenched it becomes. Monica is so used to thinking in negative ways that she re-programmes these pathways on a minute by minute basis. The only way out is to think her way out. This is where CBT or Cognitive Behaviour Therapy would be very useful; but Monica dare not try. She is too anxious to try. I believe her real anxiety is that she will realise that her life is the product of what she has made it; she can’t continue to blame the people of the past. Although they played their important role in the development of her self belief it is only down to her that she perpetuates this and down to her to change it. Unfortunately all the supplements in the world have not done that for Monica and sadly nor have I.

I include this to demonstrate that Functional Biochemistry effective as it is for most people isn’t a panacea unless you want to get well. There are many people who use illness as a crutch who need to perpetuate the illness, and hence cannot get well unless they can throw the crutch away because they no longer need it. These are usually individuals who feel deeply, they are not charlatans or horrible people; they cannot face the reality of who they are because that makes them feel unworthy. The trouble is that all of us have what are called mental mechanisms, which provide us with the ability to hide deep in our unconscious mind things that we do not want to know; so long as we hold them there, we know, with a part of us, that we are hiding something. To have to hide something means that it must be awful, and if I have to hide something awful about myself then that must make me awful; so in fear I need to hide it all the more. In reality these feelings that we hide from are usually childhood indiscretions, nothing more than a lie to escape blame, hurting somebody in our childishness. Bullying as compensation for being bullied ourselves. Whatever, if only we could face our demons we can understand them and begin to accept them and forgive ourselves. Then we having nothing to hide and that horrible feeling of guilt or shame disappears along with the mist. This is the realm of counselling, of psychotherapy, hypnosis. But counselling and psychotherapy may not work on their own because the brain chemistry is out of balance due to nutritional deficiencies. No single treatment always exists as a sole remedy.