Depression

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Depression

Depression, also called unipolar mood disorder, is characterized by depression symptoms that last at least two weeks. It affects emotions, thinking, behavior, and physical well-being. It occurs most often in people between the ages of 25 and 44. Depression is rated in terms of severity (mild, moderate, severe) and is classified by how frequently it occurs.

Signs and Symptoms

Significantly depressed mood, lowered interest or pleasure in activities (including sex), and at least four of the following are signs of depression.

	feelings of worthlessness
	self-criticism
	inappropriate guilt
	significant weight loss or weight gain
	lack of sleep or excessive amounts of sleep
	hyperactivity or inactivity
	fatigue or loss of energy
	poor concentration
	frequent thoughts of death or suicide

What Causes It?

Stressful life events and genetic predisposition are causes of depression. Here are some other factors that can put you at risk.

	family history of depression
	prior suicide attempt
	being female
	age (usually occurs under the age of 44)
	having just had a baby
	stressful life events (especially loss of a loved one) or lack of a social support system
	current or past alcohol or drug abuse

What to Expect at Your Provider's Office

Your health care provider will perform a physical examination. You may be asked questions to find out what symptoms of depression you are experiencing. Your provider may also give you blood tests or psychological tests.

Treatment Options

Treatment Plan

Treatment depends on the type and severity of your depression. Your health care provider may prescribe drugs and/or psychotherapy. Light therapy is effective for seasonal depression. Maintaining good nutrition is important. Yoga, exercise, meditation, or massage can all be helpful. If your depression is severe, hospitalization may be recommended.

Drug Therapies

Prescription

There are numerous antidepressant drugs. Follow your provider's instructions as these drugs vary in terms of dose and side effects.

	Monoamine oxidase inhibitors (MAOIs)—such as phenelzine (Nardil); severe side effects require a tyramine-free diet
	Tricyclic antidepressants (TCAs)—such as amitriptyline (Elavil); side effects include dry mouth, constipation, abnormally low blood pressure
	Selective serotonin reuptake inhibitors (SSRIs)—such as fluoxetine (Prozac) or sertraline (Zoloft); side effects include gastrointestinal upset, sedation, sexual dysfunction, and headache

Over the Counter

N/A

Complementary and Alternative Therapies

Usually a combination of nutrition and herbs will provide relief.

Nutrition

	B₁₂ and folate. Particularly the elderly are at risk for this deficiency. Dose is 800 mcg per day for folate and 100 to 500 mcg per day for B₁₂.
	Other vitamins shown to be low in people with depression are vitamin C (1,000 mg three times a day), biotin (300 mcg per day), B₁ (50 to 100 mg per day), B₂ (50 mg), B₆(50 to 100 mg per day). Minerals shown to be deficient in people with depression are calcium (800 to 1,200 mg per day), iron (15 to 30 mg per day), and magnesium (400 to 800 mg per day). A good multivitamin can efficiently address these deficiencies. In addition, chromium (200 to 500 mcg per day) helps stabilize mood changes associated with hypoglycemia.
	Essential fatty acids: depleted in depression (1,000 to 1,500 IU per day)

Herbs

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. Tinctures may be used singly or in combination as noted.

	St. John's wort (Hypericum perforatum): Numerous studies support its use in mild to moderate depression; side effects may include sensitivity to sunlight, stomach upset, headaches and rash. Dose is 1 to 4 ml tincture per day, or 250 mg three times per day when it is the only herb you are taking. It may take four to six weeks to become effective. If you are taking an antidepressant medication, do not take St. John's wort except under the close supervision of your health care provider.
	Valerian (Valeriana officinalis): sedative, with digestive problems
	Black cohosh (Cimicifuga racemosa): chronic depression, especially when caused by hormonal problems
	Ginkgo (Ginkgo biloba): circulatory stimulant, especially with decreased circulation or memory loss
	Oat straw (Avena sativa): nerve tonic, gentle, slow acting
	Siberian ginseng (Eleuthrococcus senticosus): improves ability to withstand stress
	Licorice (Glycyrrhiza glabra): antidepressant, especially for long-term stress with a digestive or hormonal component. Do not take licorice if you have high blood pressure.
	Passionflower (Passiflora incarnata): especially for emotional upheaval with nervousness and insomnia
	Lemon balm (Melissa officinalis): mild sedative and spasmolytic

A combination of equal parts of four to six herbs (1 cup tea three times a day, or 30 to 60 drops tincture) listed above can be very helpful.

Homeopathy

Homeopathy may be useful as a supportive therapy.

Acupuncture

Recent studies show that acupuncture can be effective at relieving symptoms, at times statistically comparable to antidepressants or psychotherapy.

Massage

Therapeutic massage has been shown to be effective in increasing circulation and promoting general well-being.

Following Up

Your health care provider will probably schedule a follow-up appointment with you to check on how your treatment is going. If your depression gets worse, and especially if you are having thoughts of suicide, call your provider right away.

Supporting Research

Blumenthal M, ed. The Complete German Commission E Monographs. Boston, Mass: Integrative Medicine Communications; 1998:422, 425.

Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

Gruenwald J, Brendler T et al, eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998:967–968, 1015.

Hippius H. St John's wort (Hypericum perforatum)—a herbal antidepressant. Curr Med Res Opin. 1998;14:171–184. In process.

Kaplan HW, ed. Comprehensive Textbook of Psychiatry. 6th ed. Baltimore, Md: Williams & Wilkins; 1995.

Linde K, Ramirez G, Mulrow CD, et al. St. John's wort for depression—an overview and meta-analysis of randomized clinical trials. Br Med J. 1996;313:253–258.

Rakel RE, ed. Conn's Current Therapy. 50th ed. Philadelphia, Pa: WB Saunders Company; 1998.

Reuter HD. St. John's wort as a herbal antidepressant. Eur J Herbal Med. Part 1. 1995;1(3):19–24. Part 2. 1995;1(4):15–21.

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