Depression

With the number of filled prescriptions for depression soaring, patients are often overmedicated, using pharmaceutical compounds that do not address the underlying causes, and in many cases create a situation that can inhibit true healing.
CHOOSING NATURAL OR CONVENTIONAL THERAPIES
If risk of hurting self or others  conventional therapies first and natural as an adjunct
If patient cannot take care of self or family  conventional therapies first and natural as an adjunct
If the above criteria is not met and patient is willing  natural therapies first
Pregnancy and breast feeding needs  case-by-case evaluation
If patient is on medications start by  working with natural therapies and begin to slowly taper medications after natural treatments begin to take an effect

**Introduction: **
Depression is an illness that can interfere with a person’s thoughts, feelings, behavior, and physical health. Everyone feels sad, “blue”, or “down-in-the-dumps” at times.
Depression is different.
It can last for weeks, months, or years and greatly interfere with a person’s life.
It is the leading cause of disability from medical illness. If not treated, depression can lead to suicide. The good news is that most people can be successfully treated.

Causes and presentation:
Depression is the most prevalent of all the emotional disorders. This may vary from feelings of slight sadness to utter misery and dejection. It brings together a variety of physical and psychological symptoms which collectively constitute a syndrome.
You might have depression if you have some of the following symptoms at the same time, these symptoms are different from the way we all usually feel, they last longer than two weeks, and they are interfering with your normal daily life.
 Sad or irritable mood
 Major changes in sleep, appetite, and energy
 Difficulty thinking, concentrating, and remembering
 Physical slowing or restlessness
 Lack of interest in or pleasure from activities that were once enjoyed
 Feelings of guilt, worthlessness, hopelessness, and emptiness
 Recurrent thoughts of death or suicide
 Physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and pain.

Many factors might combine together to cause a person’s depression.
It is not always clear what has caused depression for a particular person.
 The illness can run in families.
 Some diseases or medications may trigger depression.
 Life changes or long-term stress or
 The way a person thinks about or copes with this stress
 Depleted functioning of the adrenal glands (one of the main causes of mental depression.)
 Irregular diet habits cause digestive problems and lead to reduce the supply of oxygen to the tissues, which raises the carbon dioxide level, causing general depression.
 Excess intake of refined or processed foods, fried and fatty food cause weakness of the liver and fats lead to depression.
 The excessive and indiscriminate use of drugs leads to faulty assimilation of vitamins and minerals by the body and ultimately causes depression. Such as aspirin leads to deficiencies of vitamin C, B and calcium.
Sometimes there is no known reason.
No matter what the cause, chemical changes or imbalances occur in the brain when someone is depressed. This means that depression is an illness.

The good news is: Fortunately almost all people can be successfully treated for this disease.

Natural Therapy Management Plan
The modern medical system treats depression with anti- depression drugs which provide temporary relief but have harmful side-effects and do not remove the causes or prevent its recurrence. The harmful side-effects include liver damage, hypersensitivity, insomnia, a confused state, convulsions, a fall in blood pressure which brings on headaches and dizziness, blurred vision and urine retention.

The management plan for natural treatment:
 Identify / address any underlying cause,
 Diet and nutrition recommendations,
 Nutrition and botanical supplements,
 Aromatherapy
 Lifestyle recommendations (exercise, mind/body approaches and light therapy)

Dietary Recommendations:
Diet:
Diet has a profound effect on the mental health of a person. Even a single nutritional deficiency can cause depression in susceptible people.
Recommended nutritional therapy to build up brain chemicals, such as serotonin and norepinephrine that affect mood and are often lacking in depressed people
Eating foods rich in B vitamins, such as whole grains, green vegetables, eggs and fish
Following a mediterraian diet rich in fruits, vegetables, whole grains, and omega 3 essential fatty acids found in cold-water fish (such as salmon, mackerel, sardines, and herring), walnuts, flax seed, and green leafy vegetables
The diet should be restricted to three meals.
a. Morning breakfast: Fruits can be taken with milk or Greek yoghurt and a handful of nuts and seeds.
b. Lunch: Consist of steamed vegetables, whole wheat chapattis or brown pasta.
c. Dinner: Green vegetable salad with all available sprouts such as alfalfa seeds, mung beans, cottage cheese and whole wheat toast and cold water fish
Limit your intake of sweets and foods prepared with white flour (such as pastries, white bread, and bagels), alcohol, sugar, food colorings, chemical additives, white rice and strong condiments.
Drink no more than two 8-ounce beverages containing caffeine each day.

Mediterranean Diet:
A Mediterranean inspired low glycemic index, anti-inflammatory diet:
 Consist of 30% complex carbohydrates, 40% protein, and 30% lipids
 Based on consumption of legumes, fish, and low-fat dairy products
 Increase fiber intake
 Reduce intake of saturated and trans-fats.
 Avoid alcohol, caffeine, smoking, and nutritional stressors.
 Improve weight balance and advise to stabilize weight as required.
 Reduce insulin resistance, stabilize blood sugar levels, and avoid fluctuations by avoiding refined carbohydrates and sugar.
Has proven to results in:
Significant improvements in body composition, hormones and menstrual cycle regulation, blood pressure, glucose homeostasis, lipid blood levels and weight loss.
Foods included:
 Vegetables and fruit.
 Whole grains.
 Legumes (dried beans, peas and lentils)
 Nuts and seeds and olives
 Fish and poultry eaten in moderate amounts
 Small amounts of red meat
 Olive oil, as the main source of fat
 Moderate consumption of wine, mainly with meals.

. Mediterranean diet recommendations:

• 1. Choose plant-based foods most often.
• Eat a variety of raw and cooked plant-based foods, rich in fibre, nutrients, antioxidants & phytochemicals.
• Include whole grains and fruit at each meal.
• • Choose whole grains such as brown rice, barley, oats and quinoa.
• • Include whole grain couscous, wheat and rye bread and whole grain products.
• • Eat a variety of fruits such as berries, apples, pears, melon, plums, peaches and bananas.
• Eat vegetables at lunch and dinner every day.
• • Choose a variety of colors and types of vegetables such as tomatoes, spinach, peppers, zucchini and eggplant.
• • Eat three or less servings per week of potatoes. Avoid potatoes that are fried.
• • Cook vegetables in a variety of ways. Roast, sauté, steam and add them to soups.
• • Eat at least one serving of raw vegetables each day, such as green leafy salads or cut-up vegetables like carrot sticks and cucumber slices.
• Eat olives, unsalted nuts and seeds every day.
• • Sprinkle a handful of unsalted almonds, walnuts or sunflower seeds onto salads.
• • Add diced olives to salads, stews or sandwiches.
• • Snack on unsalted nuts.
• Eat legumes (dried beans, peas and lentils) at least twice a week.
• • Prepare broth-based soups and salads with brown or green lentils, chickpeas, black or kidney beans.
• 2. Drink plenty of fluids.
• Aim for 1.5 to 2.0 L (6 to 8 cups) of fluid every day. Ways to do this include:
• • Drink regular tea, herbal tea or coffee without sugar.
• • Have broth (low fat and low sodium).
• • Put a jug of tap water on the table during each meal as a reminder to drink.
• • Keep a glass of water at your desk or have a water bottle close by.
• 3. Use olive oil and add flavor to foods.
• Aim for at least 15 mL (1 Tbsp) of olive oil each day.
• • Extra virgin olive oil has more antioxidants than other types of olive oil
• • Drizzle olive oil on vegetables, salads, bread, toast and other dishes
• • Flavor food with garlic and onions instead of salt and herbs such as rosemary, oregano, parsley, basil and mint.
• • Top soups, stews and other dishes with chopped or minced garlic and onion
• 4. Include low fat milk and alternatives daily.
• Choose two servings of low fat milk (skim, 1%, 2%), lower fat cheese (20% milk fat or less) and low fat fermented dairy foods such as kefir and yogurt (0%, 1%, 2%).
• 5. Eat at least two servings of fish and seafood (75 g (2 ½ oz)) each week.
• • Include a variety of fish such as salmon, sardines, cod, anchovies and canned tuna.
• • Choose a variety of seafood such as scallops, shrimp, mussels and clams.
• 6. Include up to two to four eggs every week.
• • Prepare omelets, scrambled or boiled eggs.
• 7. Choose red meat and processed meat less often.
• • Include no more than two servings (75 g (2 ½ oz)) of red meat each week. Examples of red meat include goat, beef, pork and lamb.
• • Limit processed meat to a maximum of one serving each week. Examples of processed meat are hot dogs, sausages, deli meats, salami and bacon.
• • Replace red and processed meat with lean white meat, legumes (dried peas and lentils), eggs, fish or seafood.
• 8. Choose lean white meat at least 2 times a week.
• • Include lean white meat such as chicken, turkey or rabbit.
• 9. If you drink wine, limit to moderate amounts with meals.
• • This means about one glass per day for women and two glasses per day for men.
• 10. Limit sweets.
• • Limit sweets such as candies, pastries, desserts and sweetened pop or sweetened juice to two servings per week or less, or save them for special occasions.

Food to exclude:
Animal-derived foods and diets containing high protein and fat
Dry heat-processed foods (e.g., chips, crackers, and cookies)
Caffeine (no more than of 1-2 cups daily)
Saturated Fats and deep-fried foods no more than once weekly)
Sugar in all its forms needs to be minimized. Sugar-containing foods include fruit, which should be kept to a maximum of two pieces daily.
Refined carbohydrates such as white bread, candies, and pasta should be kept to a minimal intake (1-2 serves daily)

Enjoy a Mediterranean lifestyle.
 Make time to cook and prepare meals.
 Whenever possible, enjoy cooking and sharing mealtime together with friends and family.
 Include three meals a day.
 Aim for at least 30 minutes of physical activity each day.
 Get enough rest.
 Sharing meals with family and friends

Nutrition and botanical supplements
Several nutritional supplements may be helpful for depression,
The main supplements to start with:
 Omega-3 fatty acids,
 B vitamins,
 S-adenosyl-L-methionine (SAMe), and
 L-tryptophan (Hydroxytryptophan--5-HTP)

Omega 3 fatty acids:
Consider supplementing your diet with high-quality fish oil.
Dose:1 gm of fish oil has about 0.5-1 gm of combined omega-3s, so target 3-4 grams of fish oil daily

B vitamins:
The body needs B vitamins to make serotonin that helps the body stay in good working order.
Dose: B-100 complex vitamin (about 100 mg or ug of the B-vitamins)

SAMe:
SAMe plays a role in more than 100 different processes in the body. If someone does not have enough Vitamin B12 or folate, they will have less SAMe in their central nervous system, which can cause a depressed mood.
Dose: 200 mg twice a day up to 400 mg three times a day; ramp up slowly.
 Start at a low dose (200 mg twice a day) and add 200mg each week up to 400 mg three times a day or until you feel better.
SAMe can have side effects such as anxiety, inability to sleep, and excessive happiness.
Don’t take it before bedtime.
Do not take SAMe if you have bipolar disease since it can cause mania.

5-HTP
The supplement, L-tryptophan, is converted in the body to 5-HTP, which increases serotonin levels. Taking 5-HTP seems to improve symptoms of depression even for people whose disease has not been helped with other treatments.
Dose 50 mg to 100 mg three times a day (The dose is 150-300 mg each day)

NOTE: This supplement was initially taken off the market because some people developed eosinophilia myalgia syndrome (EMS), an incurable flu-like condition which can sometimes be harmful. The problem was traced back to contamination in one company that makes the product. This problem has been resolved and the product is again available over the counter.

Phenylalanine
DL phenylalanine: for depression along with a pain picture: 100 to 500 mg per day

Tyrosine:
Tyrosine is used to treat an inherited disorder called phenylketonuria (PKU).
People who have this problem can't process phenylalanine properly, so as a result they can't make tyrosine.
To meet their bodies' needs, dose of 500 to 1000 mg doses two or three times a day

Acetyl L-carnitine:
Recommended for old people as it decrease depression and improves mood, memory, and some measures of mental function and behavior
Dose: 1 to 4 grams a day

Inositol:
Inositol very promising in balancing certain chemicals in the body with depression associated with panic disorder, obsessive-compulsive disorder, and eating disorders.
Dose:
Depression with panic: 12 to 18 grams a day
Depression with others: 18 grams a day
.
Botanical supplements:
St. John’s Wort, can be helpful for depression in the mild to moderate range.
St. John’s Wort extract:
The usual starting dose is 300 mg three times daily.
The dosage can be gradually increased up to 1200 mg /day if needed.

NOTE:St. John’s Wort can interfere with other medications, be especially careful if you take more than one medication, birth control pills, anti-retroviral (drugs used to treat viruses such as HIV), or antibiotics (drugs used to treat infections).
St. John’s Wort can cause the skin to be more sensitive to the sun. Avoid being in the sun for long periods of time and use sun-block.

**Aromatherapy **
Uses essential oils to affect mood and promote health.
The following may be helpful for depression and are generally safe if used three times/day:
Lavender (Helpful for insomnia (difficulty sleeping) along with depression)
Citrus (Good for men with depression)
Rose and chamomile

Lifestyle:
Activity and Exercise
The depressive mood can be overcome by activity. Those who are depressive will forget their misery by doing something. They should turn away from themselves and consider others.
Exercise also plays an important role in the treatment of depression.
It provides recreation and mental relaxation.
Exercise is a nature’ best tranquilizer
Exercise produces chemical and psychological changes that improve your mental health.
It changes the levels of hormones in blood and may elevate your beta-endorphins (mood-affecting brain chemicals).
Exercise may also improve the function of the autonomic nervous system."
Exercise also gives a feeling of accomplishment and thus reduces the sense of helplessness.

Exercise recommendations:
 If you have not been exercising, start slowly and gradually increase as you are able.
 Active exercise must be undertaken each day at a regular hour.
 Find an exercise that you enjoy and that you will do over time. It helps to try different types of exercise (walking, water aerobics, biking, swimming, dancing, tennis, etc.)
 Pick some exercises that you can do indoors when the weather is bad.
 Exercise for 25-40 minutes 3-4 times a week and work up to a “14” each time.
 Participating in a group exercise with others may help you feel even better.
 It is a good idea to continue to exercise after you are feeling better; this can help prevent a relapse.
 Exercise does this better than medications do

Relaxation and Meditation
The patient must gain control over his nervous system and channelize his mental and emotional activities into restful harmonious vibrations.
This can be achieved by:
 Ensuring sufficient rest and sleep under right conditions.
 Learn the art of scientific relaxation and meditation which will go a long way in curing depression.

Meditation
Involves training the mind to remain fixed on a certain external or internal location.
All the mental faculties should be directed, without cessation, towards the object of meditation.
It can be achieved by constant practice.
Meditation will help create an amount of balance in the nervous system.
Regularity of time, place and practice are very important in meditation.
The most effective times are early dawn and dusk, when the atmosphere is serene and peaceful.

A neutral immersion bath for one hour daily is also helpful in the treatment of depression.
This bath is administered in a bath tub which should be properly fitted with hot and cold water connections. The patient should lie in the tub after filling it with water at a temperature ranging from 92 o to 98 o F. The head should be kept cold with a cold compress.

Mind/body approaches
Mind/body approaches make use of the connection between a person’s physical health and her/his mind or spirit. There are many ways to treat depression:
Cognitive therapy
Helps individuals hear the negative or distorted (inaccurate) thoughts they have and learn to replace these thoughts with positive or more accurate ones
Interpersonal therapy
Focuses on the relationships in a person’s life and communication patterns with others
It helps a person learn how current relationships might cause or maintain symptoms.
Positive psychology (Counselling)
Its goal is to improve life for people by strengthening what is positive in their lives.
Focuses on the strengths people have, what provides meaning in their lives, and helping them develop well-being
Positive affirmations
Practice thinking positive thoughts

Recommendations for self practicing:
Tools to help bring awareness to emotions:
Feelings-Images-Talk (F.I.T.) Practice: This is something you can practice on your own each time you feel a negative emotion. Exploring the following questions can help you better understand the emotion you are feeling.
Feelings: What feelings are you experiencing?
Images: What pictures come to mind with this emotion?
Talk: What are you saying to yourself?

Light therapy
What is bright light therapy (BLT)?
Bright light therapy (BLT) is a non-drug way to treat depression and sleep troubles.
BLT involves sitting in front of a light box for at least 30 minutes every morning. Light therapy can be used by both adults and children. It can be used alone or along with medications. BLT is safe, and people find it acceptable.

How does BLT work?
It is believed that the light used in BLT travels to the cells in the back of the eye. These cells send signals to the brain to change the production of brain chemicals. Low moods, then, improve with BLT because of changes in the balance of brain chemicals and changes in the sleep/wake cycle

What are the side effects of BLT?
BLT is a safe treatment for depression and some sleep conditions. There are few side effects from using a light box and generally no long-term complications. The most common side effects are headaches, eye irritation, visual glare, and feeling “wired.”
About 18% of people who use light therapy will have nausea. Side effects usually decrease with time. Side effects will also decrease if the light box is used for shorter amounts of time or if a lower intensity light box is used.

What light box should I use?
There are many different types of light boxes available. Light boxes can be purchased at most department stores and online.
Use the following recommendations to choose a safe and effective box:
- Make sure to get a box that is used to treat symptoms of depression.
- A higher intensity box will require less time per day. (A 10,000-lux light box is recommended.)
- If possible, choose a light box that emits white light. (White light has been researched the most. Blue light may also be effective, but there is less research to support using blue light.)
- Choose the box with the largest light surface that is practical for your home and budget.

**FINAL THOUGHTS
If you or someone you know is suffering with depression, consider the following:

1. Eat a healthy diet and avoid sugar, refined/processed foods, caffeine, and alcohol
2. Exercise regularly to reduce stress and improve mood and sleep.
3. Try acupuncture, massage, and professional counseling
4. Consider a supplement of SAMe or St. John’s wort.
5. Take fish oils daily for overall brain function and improved mood, and consider Suntheanine to reduce stress and anxiety.

**