Depression

Question 1

Depression

Answer 1

Characterised by persistent feelings of sadness, and hopelessness with loss of interest and pleasure in life.

Question 2

Signs and symptoms

Answer 2

• Loss of interest in usual activities.
• Loss of energy, low self-esteem, anxiety.
• Feelings or worthlessness.
• Difficulties in concentrating.
• Feeling tearful, guilt-ridden.
• Changes in appetite and weight.
• Low libido.
• Disturbed sleep.
• Self-harm, recurrent thoughts of suicide.

Question 3

Causes and risk factors

Answer 3

• Common causes include bereavements, listening to bad news (media), fear of losing work / financial worries etc. Exposure to chronic or traumatic stress in childhood or later in life.
• NT imbalances — see causes of these earlier.

– Factors such as nutritional deficiencies and SNPs associated with NT function are linked with depression, e.g., serotonergic SNPs such as TPH2.

• Nutritional — inadequate co-factors for NT production; ↓ omega-3 fatty acids (impedes FFAR sensitivity and disrupts regulation of the eCB system and HPA-axis); high sugar intake (↓ BDNF, ↑ inflammation).
• Chronic stress — (see stress lecture) prolonged elevations in brain cortisol affects 5-HT transporters.
• Gut microbiome — strongly linked with depression, anxiety etc. Depleted butyrate-producing bacteria (e.g., Coprococcus and Faecalibacterium), raised pro-inflammatory bacteria (e.g., Eggerthella).
• Chronic low-grade inflammation — ↑ inflammatory markers (e.g., CRP, TNF, IL-1, IL-4, IL-6). From diet, dysbiosis/permeability, ↑ adiposity etc.
• Hypothyroid — T3 interacts with serotonin & catecholamine receptors.
• Allergy — allergens may trigger mood changes (↑ inflammation).
• Toxicity — e.g., links with mercury, excess copper.

Question 4

Natural approach to depression

Answer 4

• CNM Naturopathic Diet with ‘Neuro Nutrition’ approach:
• The Mediterranean-style diet has been correlated with lower rates of depression. It is hypothesised that the polyphenol and fibre rich diet feeds the microbiota, reduces oxidative stress and is anti-inflammatory.
• Increase antioxidants to 8 portions colourful and seasonal fruits and veg, ideally 45–50 grams fibre per day, monounsaturated fats; a healthy balance of omega 6:3 and low saturated fat has been correlated with lower depressive rates
• Optimise digestion — nutrient absorption, reduce dysbiosis, improve gut barrier and microbial diversity. See GI health.
• Exercise outdoors (e.g., walking, running) — associated with elevated brain tryptophan and serotonin synthesis.
• Address stress; purpose, help others, problem solving.

Positive thinking / outlook, avoid news (see stress lecture).

• Sunlight — increase 5-HT; increases vitamin D.
• Diaphragmatic breathing to stimulate the Vagus nerve.
• Sleep hygiene.
• Detoxification: Address heavy metals (see detox lecture).
• Sex hormone imbalances — low levels reduce mood

Question 5

B Complex 50-150 mg/day

Answer 5

• Especially 5-MTHF, B6, B12 for methylation and NT synthesis.

Question 6

Hypericum perforatum St John’s wort Aerial parts 600–1200 mg of dry extract as 3 divided doses per day. 2 tsp infused x 3 cups daily.

Answer 6

• Thymoleptic (lifts mood), nervine tonic, anti-viral.
• Mechanisms multifactorial – COMT / MAO inhibition, ↓ serotonin, dopamine and noradrenalin, GABA reuptake; GABA A and B receptor binding, blocking GABA ligand binding. Inhibits Il-6, so↓ cortisol. Induces CYP3A4 (contraindicated with many drugs)

Question 7

Crocus sativus Saffron

Dried stigma 30 mg x 2 daily

Answer 7

• Thymoleptic — phytochemicals safranal, crocin and kaempferol inhibit serotonin reuptake. Its efficacy has been demonstrated for depressive disorders including those associated with PMS, menopause, fibromyalgia and IBS.
• Reduces anxiety and is used for general nervous debility

Question 8

5-HTP 100-300 mg daily, possibly as enteric coated to minimise digestive issues.

Answer 8

• Serotonin precursor from Griffonia simplicifolia seeds.
• May cause GI disturbances, mood disturbances, seizures, abnormal blood counts.
• GI side effects: A good starting dose is 50–100 mg / day

Question 9

Omega-3 Fatty Acids to provide minimum 1000 mg total EPA / DHA daily

Answer 9

• Maintain fluidity of neuronal cell membranes and promote FFAR sensitivity allowing NT binding and intracellular signalling — ↑ endorphin release in hypothalamus, ↓ depressive-like behaviour.
• Improve post-synaptic receptor sensitivity to NTs.
• Have a powerful effect in modulating the eCB system, which elicits effects on neurotransmission, and inflammation, as well as neuroendocrine processes through influences on the HPA-axis.
• Reduce cytokines involved in neuroinflammation

Question 10

Phosphatidylserine 100 mg x 3 daily

Answer 10

• Embeds in neuronal cell membranes, supporting NT production and post-synaptic uptake.
• Dampens effects of prolonged cortisol secretion on brain function, improves mood and sleep quality.
• Combined with DHA and EPA, PS has shown to significantly improve late life depression.

Question 11

Vitamin D — assess levels and support accordingly to optimise status

Answer 11

• VDRs are located in many brain regions including those implicated in depression (cingulate cortex, hippocampus).
• Regulates neurotrophic factors, neuroplasticity and neuroprotection. ↓ levels are linked with ↑ depression risk

Question 12

Probiotics

Answer 12

• Lactobacillus helveticus R0052 & Bifidobacterium longum R0175 reduces depression / anxiety with ↓ inflammatory cytokines, ↓ kynurenine / tryptophan ratio and ↑ BDNF

Question 13

Turmeric 1-3 g daily or 200400 mg curcumin

Answer 13

Inhibits MAO-A and MAO-B.