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Depression: The Defining Disorder of Our Time

July 17, 2016

depressed young man sitting on the bench

Depression is predicted to be the second largest contributor to the global burden of disease by the year 2020. By 2030, depression will be the #1 contributor to the global burden of chronic disease in high income countries.

There is a greater than 16% lifetime risk of major depressive disorder. Persons living below the poverty level are nearly 2½ times more likely to have depression. 43% of persons with severe depressive symptoms report serious difficulties in work, home, and social activities.

There are no laboratory tests for MDD and diagnosis depends on a trained clinician asking people about their symptoms. The estimated prevalence of depressive disorders is 13-22% in primary care clinics but is only recognized in approximately 50% of cases.

Through the lens of DSM-V, the many faces of depression include:

  • Major Depressive Disorder
  • Persistent Depressive Disorder
  • Premenstrual Dysphoric Disorder
  • Disruptive Mood Dysregulation Disorder
  • Substance/medication induced Depressive Disorder
  • Other Specified Depressive Disorder
  • Unspecified Depressive Disorder

Let’s examine the modern medical “miracle.” According to the STAR*D Trial, only 25% patients taking antidepressants long term experience remission. By comparison, the response to placebo was 20%. Ouch!!! The bottom line is that these medications appear to have a relatively small effect in patients broadly classified as having depression.

zoloft-prozac-paxil-roads

In a way, depression is probably a normal response to the stress, isolation, malnourished, sedentary and menial nature of our modern life “style. Attempts to “fix” depression with medications are not just ineffective, they silence the human spirit’s healthy and normal response to what the Hopi Indians named “Koyaanisqatsi” meaning crazy life, a life out of balance, or a way of being that by it’s very nature… cries for another.

Most people in the modern word are doing it, it’s hard to notice how sedentary our lives are. Exercise is the NUMBER ONE treatment for depression. Exercise induces the formation of stem cells, so in a way exercise juvenileses you by at least temporarily pushing the “reset button.” Both aerobic (e.g. running, swimming) and anaerobic (e.g. resistance training) exercises are effective in decreasing depression symptoms and enhancing positive mood in patients. Several studies of exercise, yoga and meditation have demonstrated therapeutic effectiveness comparable with established depression and anxiety treatments. Practically, 30 minutes/d of moderate to high intensity exercise five days a week is often cited in the literature as ideal. Realistically, we can and should asses the current level of fitness and start low and build up to individually “ideal” doses.

Just as important as movement as a therapy for depression, is adequate rest. 7.5-9 hours of good quality sleep is essential.

Although it not a pretty picture, our brains are basically big bags of fat waiting to go rancid. Given the prevalence of fried foods, fake fats, and corn fed animal products, its no wonder that even though it is “standard” our the standard American diet is fueling the modern epidemic of depression. Consuming healthy fats like EPA and DHA, phosphatidyl choline, uncooked vegetable oils amounts to an “oil change” for your brain, and can be really helpful for cognitive function and resilience.

We’ve been hearing a lot about the value of probiotics to reduce inflammation and promote more ideal digestion and assimilation. For mental health, the “gut-feeling” adage is very real. There are far more neurotransmitters made in our guts than our brains. Having a healthy gut flora ecosystem can not be underestimated, and new research is coming out that taking probiotics can actually have a profound antidepressant and anxiolytic effects.

There’s no better way to change your gut flora than to change your diet, and for this and many other reasons, the healthiest diet is one similar to what we would have been eating BEFORE agriculture: vegetables, berries, fruit, eggs, wild fish, free-range meats. Simply put, this means taking out all grains and processed foods. I often tell my patients to completely avoid the middle aisles in grocery stores–there’s nothing you need there. Avoiding sugar, gluten (from wheat, barley and rye) and dairy. Not just for depression, this kind of cleaned up, whole food ancient diet can address the underlying causes of myriad conditions and symptoms.

Genetic differences in the methylation cycle are getting a lot of press these days. It’s true that variations in the 667 and 1298 position on the MTHFR enzyme are quite common. Over 40% of the population has at least one of the eight possible combinations of variants in just these two positions. The prevalence of these variants in depressed people is nearly double. Taking methylated folate (5MTHF) leap-frogs over the genetic variants in MTHFR, and so taking this along with appropriate amounts of other methylation cofactors (B1, B6, B12, Vitamin C..) can be profoundly helpful in some cases of physiologic depression and anxiety.

Beyond exercise, sleep, a clean diet, healthy fats, other things we can do to support optimal mood including breathing, mindfulness meditation, adopting a pet, and cultivating gratitude and acceptance.

Supplements that can help depressive states include: 5HTP, L-theamine, SAMe, DHEA, EPA/DHA and adrenal support. I do use these to help some patients get traction, but they are not substitutes for the fundamental modifiable lifestyle factors: Exercise, Sleep, A clean diet and stress reduction.

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