I was deeply saddened by the death of Robin Williams last week. He was one of my favorite comedians.  I still vividly remember first seeing him as “Mork from Ork,” and sensed then he was headed for great stardom. His comedic brilliance brought me often to tears.  Birdcage remains as one of my favorite comedies of all time.

We often think of celebrities as living glamorous lives, far more enriched than ours due to their fame and fortune.  While the limelight may encourage us to believe as such, the truth is  money or fame do not buffer or protect us from living with ourselves and our emotional realities.  It doesn’t give anything beyond temporary happiness, for the most part.  Celebrities as members of our human family, are just like us. We all have our ups and joys, our joys and triumphs, our tragedies and despairs.

Robin’s tragic death, is now shining a light on depression and provides an opportunity to reconsider our standard approach to treating this disease that affects millions of Americans. Until we address this and other mental health disorders in a comprehensive and holistic way, that corrects depression's underlying brain dysfunction, we will continue to witness such unfortunate and untimely deaths as his.

Depression is an unpredictable, unrelenting emotional tsunami, that can overwhelm, devastate, and end a life.  Robin was not alone in his suffering, as more than 300 suicides occur each and every day of the year.  According to the CDC over 9.1% our population, almost 35 million Americans are living with this disease. The trauma and aftermath of war has made our returning veterans extremely vulnerable to depression and suicide.It is predicted that 50% of all Americans at some point during their life experience an episode of depression.

The great tragedy of experiencing depression in the United States is that anti-depressant medications do not effectively treat this disorder.  Why? Conventional medicine overlooks several important biological factors that influence depression, thereby undermining the likelihood that a holistic strategy will be employed to thoroughly manage a patient’s depression.

Depression One or Many Causes?

Because there are many factors that contribute to depression, effective treatment requires addressing the numerous changes in brain chemistry and metabolic imbalances that contribute to the development of mood disorders.  There are effective, safe natural evidence based mechanisms for brain health that indicate why anti-depressants, aren’t enough.  Nutritional deficiencies and insufficiencies, hormonal imbalances, inflammation, stress all play a role.  Therapies addressing these issues compared to pharmaceutical therapy, do provide significant symptom relief for those suffering from this disorder.

The mainstream view on the cause of depression relies largely on the monoamine hypothesis - a theory proposing that deregulation in neurotransmitter signaling is the sole cause of depression. This is the reason for the focus on prescribing antidepressant drugs in the management of depression for decades.  Tragically, this theory fails to take consider various other well-studied causes, and partly explains the poor success rate of antidepressant medications.

The great tragedy of experiencing depression in the United States is that anti-depressant medications do not safely or effectively treat this disorder.  While medication is the frontline treatment.  Unfortunately, the success rate of drug treatment for depression is a mere 50% or less and these drugs  have significant potential side effects, including an increased experience of suicidal ideation with some of them. Several studies have found that anti-depressant medications are no more effective than a placebo!

There are many physical factors that contribute to depression, nutritional deficiencies and insufficiencies, hormonal imbalances, inflammation, stress.  There are effective, safe natural therapies, primarily nutritional, that have been researched and compared to pharmaceutical therapy, which provide significant symptom relief to those suffering from this disorder.

It is imperative to reconsider our approach to treating depression.  Until we address this mental health disorder in a comprehensive, way and correct depression's underlying multiple brain dysfunctions, we will continue to witness such unfortunate and untimely deaths as his and millions will continue to suffer without meaningful clinical improvement and relief from the grip of its symptoms.
What is Depression?

Depression is a mental disorder characterized by a wide range of negative feelings ranging from minor unhappiness to unspeakable and incomprehensible despair. While it is considered to be a mental health condition, physical symptoms frequently occur, especially in the more severe forms, including, loss of energy, severe pain or other physical symptoms. Depression has a tremendous impact on the lives of those experiencing it.  Depression can adversely affect the course and outcome of common chronic conditions, such as arthritis, asthma, cardiovascular disease, cancer, diabetes, and obesity. Depression also can result in increased work absenteeism, short-term disability, and decreased productivity.

The underlying the causes of depression is complex and variable among individuals; both psychological and biological factors influence a person’s state of mind at any given time. For example, emergent research links depression with several metabolic phenomena, including inflammation, insulin resistance, and oxidative stress. Intriguing preliminary data also suggest that mitochondrial dysfunction (mitochondria is the a cellular structure that produces energy plays a previously unappreciated role in depression. Moreover, the role of hormones in depression is considerable, including stress hormones (glucocorticoids) and sex hormones (testosterone, estrogen). Many people affected by depression may be suffering from hormonal imbalances that are significantly contributing to their symptoms.

There is a genetic link, according to research.  Approximately 30 to 40 percent is attributed to genes, while 60 to 70 percent of the factors are environmental.

We must acknowledge and appreciate the complex nature of depression and advocate a comprehensive management strategy that includes proactive lifestyle changes, behavioral therapy, hormone restoration, and targeted nutritional support to complement conventional antidepressant treatment and balance brain chemistry holistically.

Depression in U.S. Adults

The CDC estimates indicate that, among 235,067 adults (in 45 states, the District of Columbia [DC], Puerto Rico, and the U.S. Virgin Islands), 9.1% met the criteria for current depression (significant symptoms for at least 2 weeks before the survey), including 4.1% who met the criteria for major depression. In this study, increased prevalence of depression was found in southeastern states, where a greater prevalence of chronic conditions associated with depression has been observed (e.g., obesity and stroke). By state, age-standardized estimates for current depression ranged from 4.8% in North Dakota to 15.0% in Puerto Rico.

Who Tends to be Most Depressed?

This study found the following groups to be more likely to meet criteria for major depression:

  • persons 45-64 years of age
  • women
  • people of color (blacks, Hispanics, non-Hispanic persons of other races or multiple races)
  • persons with less than a high school education
  • those previously married
  • individuals unable to work or unemployed
  • persons without health insurance coverage

Similar patterns were found among persons with "other depression" with the two following exceptions: adults aged 18-24 years were most likely to report "other depression" as were Hispanics (instead of other non-Hispanics)

Symptoms of Depression

A diagnosis of clinical depression requires that the patient experience at least five of the nine symptoms below, for most of the day, nearly every day, for at least two weeks. One of the symptoms must be either a constant feeling of sadness, anxiety, and emptiness, or loss of interest in formerly pleasurable activities.

If any of these symptoms affects your relationships and your ability to function at home or work, consult with a health care practitioner qualified to assess and treat depression.

Emotional Symptoms

  • Constant or transient feelings of sadness, anxiety, and emptiness
  • Feeling restless; may experience irritability
  • Feeling hopeless
  • Feeling worthless or guilty for no reason; suicidal thoughts may occur
  • Loss of interest in activities or hobbies once enjoyed; may lose interest in sex

Physical Symptoms

  • Disturbed sleep patterns; may sleep too little or too much
  • Low energy; fatigue
  • Significant weight loss or gain due to a change in eating habits; either loss of appetite or eating too much
  • Difficulty concentrating, remembering details, or making decisions

Depression Causes

Because there are many factors that contribute to depression, effective treatment requires addressing the numerous changes in brain chemistry and metabolic imbalances that underlie mood disturbances.  There are effective, safe natural evidence based mechanisms for brain health that indicate why anti-depressants, aren’t enough.  Nutritional deficiencies and insufficiencies, hormonal imbalances, inflammation, stress all play a role.  Therapies addressing these issues compared to pharmaceutical therapy, do provide significant symptom relief for those suffering from this disorder.

The mainstream view on the cause of depression relies largely on the monoamine hypothesis - a theory proposing that deregulation in neurotransmitter signaling is the sole cause of depression. This is the reason for the focus on prescribing antidepressant drugs in the management of depression for decades. While changes in the brain chemistry do occur, and these medications, may be helpful, some researchers believe the deregulation is secondary and not a primary cause of depression.   Tragically, this theory fails to take consider various other well-studied causes, and  in part explain the poor success rate of antidepressant medications.

It is imperative to reconsider our approach to treating depression.  Until we address this mental health disorder in a comprehensive, way and correct depression's underlying multiple brain dysfunctions, we will continue to witness such unfortunate and untimely deaths as his. We will continue to bare witness to  more suicides, and millions suffering without meaningful clinical improvement and relief from the grip of its symptoms.

Types of Depression and Associated Symptoms

Depression is distinguished into several clinical presentations. The most common are major depressive disorder and dysthymic disorder.  The spectrum of depressive disorders include:

Major depressive disorder (major depression): Major depressive disorder is quite often disruptive, and prevents the patient from living and functioning normally. A combination of symptoms interrupts the patient’s ability to sleep, study, work, eat, and experience the pleasures of life.  Some people may experience only a single episode, while others experience recurrent episodes.

Dysthymic disorder (dysthymia): Dysthymia, also known as chronic mild depression, lasts longer than two years. Symptoms are not disabling or as severe as those of major depression, however the individual experiences difficulties functioning normally and does not feel healthy. A person with dysthymia may also experience periods of major depression.

Psychotic depression: Psychotic depression is a severe depressive illness that also involves the experience of hallucinations, delusions, or withdrawal from reality.

Postpartum depression (postnatal depression): Postpartum depression, also known as postnatal depression (PND), is experienced by 10% to 15% of all mothers after giving birth of their child.  This is not to be confused with the “baby blues,” which a mother may feel briefly after giving birth. The development of a major depressive episode within a few weeks of giving birth likely indicates PND.  Tragically, many remain undiagnosed and suffer for long periods without treatment and support.

Seasonal affective disorder (SAD): Is related to decreased light exposure during winter months. Its incidence increases in proportion to the distance from the equator. A person who develops a depressive illness during the winter months with symptoms that go away during spring or summer may have SAD. Accumulating evidence points to vitamin D deficiency as a contributing factor in SAD and in other forms of depression.

Bipolar disorder (manic-depressive illness): A patient with bipolar disorder experiences (frequently extreme) highs (mania) and lows (depression) in mood. The rate at which an individual symptoms change from mania to depression, and vice-versa, determines where they lie on the bipolar spectrum (a continuum of symptom severity).

Causes of Depression

Studies conducted since the 1980s have evaluated a variety of factors that contribute to the development of depression. They include brain chemistry, early life trauma, negative thinking, one’s personality and temperament, stress, genetics and relationship difficulties.  The latest research suggests that brain biochemistry including inflammation, oxidative stress, and hormonal imbalances can cause or worsen depression as well.

The mainstream view on the cause of depression relies largely on the monoamine hypothesis - a theory proposing that deregulation in neurotransmitter signaling is the sole cause of depression. This has been the grounds for prescribing antidepressant drugs in the management of depression for decades. However, this theory fails to take into account various other well-studied causes, and partly explains the poor success rate of antidepressant medications. Conventional medicine overlooks several important biological factors that influence depression, thereby undermining the likelihood that a holistic strategy will be employed to thoroughly manage a patient’s depression.

Critical omissions from conventional assessment of depression include:

  • Hormone imbalances and deficiencies (stress, thyroid, and sex hormones)
  • Nutritional deficiencies
  • Oxidative stress and mitochondrial dysfunction
  • Chronic inflammation
  • Personal relationship challenges
  • Previous trauma

 

Impaired Stress Response

When we perceive a stressful situation,  regardless of its cause, our bodies respond, and attempts to adapt to the perceived danger.  This response involves the release of or stress hormones, which stimulate significant protective  changes throughout the body.

A stress response is designed to help us confront or escape danger by redirecting blood flow to the muscles, dilating the pupils, inhibiting digestion, and releasing stored fatty acids and glucose (blood sugar) to be used by the muscles. This process is known as the fight-or-flight response.

The relationship between chronic stress, depression, and anxiety is complex, but incredibly powerful. The continuous release of stress hormones, actually alters the brain’s structure.  Chronic exposure to glucocorticoids interrupts contact between dendrites, the branches of neurons that receive signals from other neurons, into less functional patterns.  Research links this phenomenon with alterations in mood, short-term memory, and behavioral flexibility.  Stress hormones also decrease the brain’s sensitivity to serotonin, the mood-regulating neurotransmitter most often associated with depression. Chronic stress also increases one’s susceptibility to brain cell damage and impairs the creation of new brain cells.

Interestingly, emerging research suggests that drugs used to treat anxiety and depression may stabilize mood not only by acting on neurotransmitters, but also by regulating the brain’s receptors for stress hormones. These new findings strongly support the importance of controlling the stress response in order to alleviate mood disorders. Indeed, several genetic and epidemiological studies have linked excessive stress, and the inability to adapt efficiently to stress, with increased rates of anxiety and depression.

Optimism (a positive outlook) provides physiological protection from the development of chronic diseases, including depression. In part, it may be due to the difference in perspective that promotes the release of chemicals within the brain that supports brain function.

 

Chronic Inflammation

Several studies support the role of inflammation and immune system deregulation in depression. Studies have found elevated levels markers of inflammation in patients suffering from major and late-life depression, as well as in those who did not respond to SSRIs anti-depressant drugs. Studies  have also found a link between generalized markers of  inflammation marker C-reactive protein (C-RP) and major depression. Moreover, elevated CRP levels are associated with a number of other significant health problems such as cardiovascular disease.

In prospective studies involving patients being treated with recombinant cytokines for immune-related conditions, depression is observed to develop after inflammation initiates several other undesirable metabolic cascades. This has lead some researchers to identify depression as a late-stage consequence of chronic inflammation.

Hormonal influences

Thyroid hormones affect metabolism and brain function, and low thyroid activity can contribute to depression. Conventional medicine relies on overly broad thyroid lab ranges, failing to recognize many cases of sub-optimal thyroid function.

Clinical hypothyroidism is known to interrupt serotonin signaling in the brain, which can contribute to depression.  Also, adequate levels of thyroid hormone is required for the brain to function optimally, a low thyroid hormone status can promote  loss of function and degeneration in the brain, including the areas of the brain that regulate mood.

Sex hormones also influence mood and depression. Women are more susceptible to anxiety than men and also experience more depression when they are pregnant, postpartum, premenstrual and menopausal than at other times in life. These general observations have piqued the interest of scientists and given rise to an expanding body of research linking depression with sex hormone imbalances.

By now, it is well known that most steroid hormones (e.g., pregnenolone, estrogen, progesterone, testosterone, and DHEA) are active in the brain, as it n contains large numbers of receptors for DHEA, estrogen, and progesterone. These hormones affect many functions in the brain, including the regulation of mood.

Accordingly, a number of studies link hormonal imbalances to various depressive disorders in men and women.  Low levels of estrogen in women and  testosterone in men have been linked to depression. Despite these findings, hormone levels are rarely evaluated and addressed while treating depression.  Instead, they frequently dismiss such imbalances as a normal part of aging, while in truth, restoring hormone levels may effectively address multiple health deficits associated with aging, including mood imbalances.

 

Nutritional deficiency or insufficiency

Nutrition plays an essential role in brain function, and poor nutrition significantly increases one’s risk for depression. Dietary nutrients influence nervous system function in multiple ways. Important dietary nutrients include:

  • B-complex vitamins: B-complex vitamins serve as cofactors for the production of neurotransmitters. Inadequate levels of B-vitamins, especially folate, vitamin B12, niacin, and vitamin B6, can disrupt neurotransmitter synthesis. This not only may lead to mood alterations, but also can affect l brain function, memory, and cognition.
  • Optimal balance of omega-3 and omega-6 fatty acids: Fatty acids are critical components of nerve cell membranes and play an important role in neuronal communication. Fatty acid imbalances can impair the transmission of messages between nerve cells, leading to cognitive deficits and mood alterations, including depression.  Residents of countries with higher levels of fish consumption experience lower rates of depression.
  • Vitamin D activity: A vitamin-D deficiency, which is one of the most common vitamin deficiencies is associated with seasonal depression. Recent studies indicate it also may play a role in the development of non-seasonal depression through its considerable influence on genetic activity, its ability to control inflammation, and other mechanisms.

Oxidative Stress and Mitochondrial Dysfunction

Brain tissue is particularly susceptible to oxidative damage due to its high concentrations of phospholipids and the exhaustive metabolic rate among neurons. A growing body of research suggests that oxidative stress contributes to depression and other brain-related disorders. This is thought to result from either an increase in damaging reactive oxygen species, a decrease in antioxidant defense mechanisms, or a combination of the two. These mechanisms become especially important with advancing age.

Newer research sheds light on the critical role of mitochondria and neurotransmission and mood regulation. Mitochondria are the “powerhouses” in each cell that generate energy. In an intriguing study, researchers measured the content of mitochondrial DNA within white blood cells in aging patients who were depressed, and in an age-matched group who were not depressed. The subjects with depression had significantly fewer mitochondria than non-depressed controls, leading researchers to suggest, “mitochondrial dysfunction could be a mechanism of geriatric depression”. In a similar study, greater numbers of mitochondria in peripheral cells were associated with improved cognitive function in healthy elderly women.

Traumatic events and Post-Traumatic Stress Disorder

Research establishes that trauma, such as the sudden loss of a family member, sexual abuse, or war-related traumas, contributes significantly to prolonged periods of depression. The effects are more pronounced when the trauma occurs in childhood; childhood trauma can considerably alter the structure and function of the brain, increasing susceptibility to depression and anxiety later in life.

Social network and personal relationships

The absence of meaningful social contact with others has been linked to depression, while evidence increasingly shows that close personal relationships and social networks positively affect mood and health. Loving relationships, social connection and support, work-related passion and recognition, and a good marriage help prevent depression.

Physical Conditions with Higher Rates of Depression

Depression is more common in those with, heart disease, stroke, diabetes, cancer, diabetes Parkinson's disease, and many other illnesses.  Studies have found that depression increases the severity of symptoms, and makes coping with the illness much more difficult.  Studies also show that treating depression in this population may improve symptoms of the co-occurring illness in some instances. Robin Williams’ wife announced a few days after his death that he was struggling with the early stages of Parkinson’s disease.

Also, drug and alcohol dependency is also linked to depression.

 

Coming Up

Next week we’ll take a look at a comprehensive, evidence-based holistic treatment approach to depression.

 

Resources:

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2 Comments

  • Thank you so very much for this conversation about depression in all of its forms. As a Pastoral Counselor/Marriage and Family Therapist in private practice, most of the clients are experiencing some degree of anxiety/depression (melancholy). Your conversation outlining the strengths, side effects, and limitations of medications is essential for all of us to understand, clients, patients, practitioners from various disciplines of care as well as our highly judgmental society. As an African American pastoral psychotherapist, this information is especially essential in our specific community. I yearn for the day when our most esteemed institution, the Black Church, can become more open to what you are sharing and move from making this only a ‘spiritual’ problem. Again, thank you.

  • Hi Bernard, You’re more than welcome! It is my pleasure to be of assistance in any way that I can. And thank you for your support and insights. I agree with you wholeheartedly.

    Love and blessings,
    Dr. Elaine

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