Dr William Goldwag

Depression is an extremely common problem in America; it affects people of all backgrounds. There are different degrees of depression, and its treatment has varied considerably over periods of time and with the severity of the condition.

Some of us call it depression when somebody has just a little bit of mild sadness. Commonly, when we lose someone close to us, if someone dies, or if we lose a job or have some disappointment, there's apt to be a mild reaction in almost everybody. There will be some sadness, perhaps some grief. Usually there's a set period of time that that lasts. When it goes on much longer, or when it becomes much more profound, then we refer to it as depression.

Causes of Depression

Genetic factors may be involved in depression, factors related to changes in the brain metabolism and the nervous system. It's common for depressed people to have a family history of depression. This may be due to environmental factors, experiences in depressed families, or poor eating habits that are passed on from one generation to another.

Environmental Factors. Environmental factors can include being brought up in a family in which one or more people are depressed. Just being exposed to depressed people can be an influence, since children learn how to behave by imitation. Also, family members are eating the same food, so that, for instance, if the mother is depressed and cooking and serving her family, that food is apt to be sparse in nutrients since she is interested in just getting the meal over with. She has difficulty finding enough energy to prepare it.

Being abused physically or verbally can be another factor that inhibits children. As a way of handling abuse the child may withdraw and become depressed and inactive as a defense against very harsh treatment from the parent.

Genetic Factors. We know about genetic factors through the action of certain drugs. We see what chemical changes take place. Obviously our chemistry is to a great extent determined by our genes. There are genes presently under investigation that are believed to be responsible for manic-depression-type illnesses, in which one fluctuates from hyperactivity to depression or limited activity. Every day another gene is being found that is responsible for some of these illnesses. The gene expresses itself through a change in chemistry.

Treating Depression

In the past, before drug therapy became popular, severe depression was treated with hospitalization and electroshock therapy, sometimes even insulin shock therapy, the idea being that somehow or other when you shock the brain it shakes things up. A lot of the disturbed thought processes seemed to almost get blanked out, and you could sort of start all over again with an individual.

Psychotherapy, of course, has always been popular. That can range from just the presence of a close, supportive friend or relative to more in-depth treatment with a psychiatrist or psychologist.

There are many, many things that individuals can do to help themselves. What we want to ask is, what can we do nutritionally and in other ways? What lifestyle factors are under our own control that we can manipulate in order to alleviate symptoms of depression or prevent them?

Exercise. Exercise is one of the most profound aids in the treatment of depression. One of the major errors in the thinking of patients and therapists is the notion that in order to be active you have to feel better. This is exactly contrary to what we are recommending.

We recommend that you do first, and then the feeling comes later. In other words, you must do what you have to do regardless of how you feel. This aids in feeling better. You can't wait until you feel good and then do something, because in depression that may take days, weeks, months, or even years. You want to accelerate the process.

Those of us who exercise regularly have had days when we just didn't feel like it. That's the way depressed people feel about everything. They just don't feel like it. They don't have the energy, the motivation, the stimulation to go and do even the ordinary things. When it's severe, the person may not even have the will or desire to get out of bed in the morning.

The exercise may consist of very, very simple things, like just getting out and walking, getting up and doing some simple movements, some mild calisthenics, any kind of physical movement that gets the body in action. For some people just getting out of bed and getting dressed is a big accomplishment. That may be the first step.

It is important for depressed people to get up and get dressed. They should not walk around in the pajamas or nightgowns because this maintains that connection to the bed and the bed means inactivity. That's the thing you're trying to overcome. It may be walking, walking the dog perhaps, or going outside to do some simple gardening. These are all very important for overcoming that feeling of lassitude that is so characteristic of depression.

Another benefit of exercise is a feeling of accomplishment. Even doing a little bit of exercise will make you feel more energized later on. Finishing an exercise routine, even one that's fatiguing, after a brief period of rest, will give you a feeling of revitalization, of energy, and a psychological feeling of accomplishment. It gives a feeling of, "I've done it." "It's completed." For the depressed individual, some kind of feeling of worthiness or self-esteem is important.

Helping Others. The next step may involve doing some volunteer work, getting out and doing things for other people. This is very important in trying to get the depressed person's mind off himself or herself. Depressed people are continually negative. They have dark thoughts, guilt, sad feelings, grief, regrets. This is characteristic of depression. You can't talk them out of it or try to convince them otherwise, but you can distract them. Physical activity is one distraction. Doing things for other people is another. So getting the person involved in someone else's problems is a very effective way of dealing with depressed individuals.

Nutrition. Nutrition is important in preventing depression and treating it. Often the nutrition suffers in depressed people. If the depression is profound, the individual doesn't even feel like eating. Depressed people who live alone or who are major providers or cooks in the house may not feel like preparing meals or even shopping. They're apt to restrict their nutrition to fast foods or empty calories or just anything to get eating over with. In many cases, weight loss is a symptom of severe depression.

Of course, when this occurs, there is going to be marked deprivation of essential nutrients, of sufficient amino acids to manufacture the proper proteins, a deficiency in many of the vitamins and minerals. That in itself can then aggravate the depression.

There are some simple ways to prepare food in advance so that the food has to be prepared less often. I recommend preparing a raw salad once a week. Certain fresh vegetables can be stored for quite a period in a refrigerator and will keep quite well. There are a whole variety to choose from: carrots, celery, radishes, cauliflower, broccoli, peppers, red cabbage, green onions, snow peas, string beans. These can all be cut up and mixed together. They can be stored in a plastic bag or sealed container. When mealtime comes, a person can take a handful of these vegetables and then perhaps add some other ones that don't keep as well, such as tomatoes or sprouts. You then have a fresh salad that is already prepared with a lot of important nutrients. This is just one way of having food prepared in advance. It's good for people who are depressed and don't have the energy to make a whole meal.

B Complex Vitamins. One of the major groups of vitamins to incorporate are from the B complex family. Years and years ago, when people suffered from severe vitamin deficiencies, some of the resultant diseases like pellagra and so forth were characterized by psychotic reactions. That is, the thinking process was the most obvious one to be affected. Simply providing the proper vitamin, in this case vitamin B3 or niacin, was the treatment. It cleared up the psychosis.

There's no question that brain function is very dependent upon nutrients like niacin and others, because when they're absent there is apt to be some very disturbed thinking. Depression is one of the symptoms that can occur with this.

It is important to get all the B complex vitamins, since they work together. Thiamine, B1, is important, as is riboflavin to a lesser extent. Another important one is B6, pyridoxine. B12 is still another one that can affect the mental processes.

Niacin is often used in much higher doses than the others in order to accomplish some of these changes. Niacin is a ubiquitous vitamin. It is being used greatly to help reduce cholesterol levels, to improve the good cholesterol and reduce the bad. The dosages are much greater than those used to simply overcome a deficiency.

Tryptophane. One of the chemicals in the brain that seems to be deficient or low in depressed people is serotonin. We know this from experiments in which certain drugs that preserve serotonin from being destroyed by the system seem to work as antidepressants. The theory is that whatever can supply or aid the serotonin factor will help depression.

Tryptophane is an amino acid that helps to increase brain serotonin. Some foods contain tryptophane and can act as antidepressants. It is found most abundantly in milk and turkey. Tryptophane used to be an amino acid that was obtainable until the FDA took it off the market several years ago because there were some serious blood problems in people who took it. This was later tracked down to a contaminant; the problem was not due to the tryptophane itself. Unfortunately the FDA has been rather lax in not allowing it back on the market again. Increasing the intake of milk and turkey are at least two ways of getting tryptophane.

What to Avoid

Eating fast foods can affect mental symptoms by causing blood sugar abnormalities. People who tend to hypoglycemia or low blood sugar patterns should avoid eating too many simple carbohydrates, the ones that are converted very rapidly to sugar in the blood. They may temporarily raise the blood sugar, but then they drop it to a very low level several hours later, resulting in depression. Then people are apt to repeat the cycle of taking sugar or some simple carbohydrate that's converted to sugar in order to feel that high again. They're constantly going from high to low. This can account for many episodes of depression in individuals.

People who overindulge in alcohol are apt to have periods of depression quite often. Some individuals think alcohol stimulates. It does help one lose some inhibitions and feel more at ease and relaxed, but it is a depressant and in higher doses it can obviously knock somebody out. It should be avoided.

People on very strict weight-loss diets may go for long periods of time either fasting or eating very few B-complex-containing foods. They may suffer from depressive symptoms. Again, we're talking about not just a little bit of a let-down feeling, but about more severe depression.

Characteristics of a Severe Depression

There are about eight or nine characteristic signs of depression. Generally these should be present for at least two weeks and represent a change from a previous state: They are reduction in appetite, reduction in sleep ability, fatigue, lack of energy, agitation or retardation in motor activity, loss of interest in usual activities, loss of interest in sex, feelings of worthlessness or guilt, slowed thinking, inability to concentrate to a severe degree, and recurring thoughts of suicide, or suicide attempts.

Everybody from time to time has some of these symptoms. Only when about four or five of these are present for a long period of time, and when they are different than a person's usual personality, is depression something to be considered.

Changes in Recent Years

The first drugs ever used for treating depression were the amphetamines. In their time, before they got such a bad reputation, they were considered helpful. In the old days--20, 30, or 40 years ago--amphetamines were used for weight control. They did diminish the appetite, and they also made a person feel good, alert, and more energetic. People who went on diets and took amphetamines felt great.

Of course, a problem came when you stopped the amphetamines. People would go into a depression. For that reason amphetamines became very habit-forming. In order to feel good a person had to keep on taking them. For many people that was okay. For a fair percentage, though, the dose became inadequate or the person started feeling like they needed more and more of the drug. This created all kinds of problems with the body's chemistry.

There are still some medications on the market that act a little bit like the amphetamines, although they are not anywhere near as powerful. These are mild sympathetic nervous system stimulants that are sold over the counter, such as those people use to keep awake when they have to drive. In some instances I'm sure there are people who take them as a way of counteracting depression.

The next group of drugs to come along were the tricyclic antidepressants. They're called tricyclic because of their chemical structure, which is a triple cycle. There are a whole bunch of them now on the market. The newer group are those that inhibit the enzymes that break down serotonin. They are designed to try to raise the serotonin level in the brain. In that way they counteract depression.

They are all to varying degrees effective, but they all have side effects. Some of the side effects are severe; some are mild. They usually take days or weeks before they are effective, and in this way they are different than the amphetamines used to be, because those would work in a matter of minutes or hours. Of course, in the long run the present-day antidepressants may be more effective.

As far as nutritional protocols, the ones I know of that are of practical use are the ones that use high doses of B complex, specifically niacin. Those have been used for some time now. You have to be a little bit careful of niacin because over long periods of time, in high doses, there can be some effects on the liver.

The doses of niacin that have been used, mostly by Dr. Hoffer, have been in the ranges of 4, 5, or more grams a day. That's thousands of milligrams a day, whereas the requirements for avoiding a deficiency are measured in just 10 or 20 mg.

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