Clinical Nutrition and Depression/Anxiety Issues
24 hours a day, 7 days a week our senses are bombarded with images and sounds of a world fraught with difficulty. Twenty four hour a day television, radio and the internet crash their way relentlessly into our private worlds, bringing us visions of terror, death and despair from around the globe. It is hardly surprising that depression and anxiety disorders haunt us in ever increasing numbers. While cancer and diabetes grab the headlines, it is depression which fifteen years from now is projected to become the second most common cause of disability for all ages and both sexes, worldwide. In any given year, nearly ten percent of the western world suffer from depression, with women at almost double the risk of men. Between the ages of 18 and 24, depression is our leading cause of premature death and disability.
The treatment of depression and anxiety disorders invariably centres on pharmaceutical medications such as antidepressants and tranquilisers. Often, but not always, adjunctive psychotherapy or counselling is used. While antidepressants are one of the most widely prescribed classes of medication, their efficacy and dangers remain a subject of scientific debate. Some studies indicate their effectiveness to be no greater than placebo. The most widely prescribed antidepressant, Fluoxetine Hydrochloride belongs to a group of drugs known as SSRI’s. Treatment with Fluoxetine has been shown to produce a 50% improvement in symptoms in only 38% of those who start treatment, and in only 56% of those who complete a full course. Discontinuation rates are high with 27 out of 100 patients receiving a SSRI during a six week trial stopping treatment because of side effects. Of late debate has centred on research indicating an increased risk of suicide amongst antidepressant users, especially young people and children.
While antidepressants are often credited with potentially lifesaving therapeutic effects, lifestyle and dietary changes and clinical nutrition offer huge therapeutic benefits to many depressed or anxious people. Whether your tablet of choice is an antidepressant, a herb or a nutritional supplement, simply swallowing a pill without addressing the bigger picture of your life, is nothing more than a short term “bandaid”. Seventy percent of people who are prescribed antidepressant therapy experience a relapse at a future date once off their medication. For most people resolving emotional issues or addressing areas of chronic conflict in their life is an important part of long term recovery. Daily living practices also need to come under the microscope. If you’re running on empty, with little sleep, a poor work/life balance, no times of joy and relaxation, few close nurturing personal relationships and friendships, and no time for exercise, you’re a walking prescription for anxiety and depression. Simply swallowing a pill without also addressing the bigger picture of your life may well prove to be a futile act of self delusion.
Many New Zealanders start their day with a nutritious breakfast and a nutritional supplement or two for good measure. While multivitamin and mineral tablets are a useful way of covering all the nutritional bases, specific nutrient therapy has has much to offer in restoring balance to a frayed or depressed nervous system.
It is widespread knowledge that omega-3 essential fatty acids offer health giving benefits to the heart and cardiovascular system. What is less widely known is their positive therapeutic effect in both the prevention and treatment of anxiety and depression. EPA and DHA are components of the naturally occurring Omega-3 fatty acids found in fish oil. Both EPA and DHA are essential for healthy function of neurons, and low DHA levels are associated with accentuated stress response in the brain and nervous system, along with low levels of the neurotransmitter serotonin. This is important as depression is sometimes rather simplistically referred to as a “serotonin deficiency” syndrome.
Depressed people often have lower than average levels of omega-3 content in their blood, and supplementing with high doses of fish oil frequently reduces depression and anxiety symptoms, even in people already using antidepressants. Patients unresponsive to treatment with SSRI’s often respond to the drugs when omega-3’s and folate (a B vitamin) were added to their drug regime. Women suffering from aggression and hostility related to Borderline Personality Disorder have been shown to have a marked decrease in mood reactivity when supplemented with 1g of EPA daily. As little as 1000mg of fish oil a day can reduce symptoms of sadness, anxiety and insomnia in depressed people.
With the obsessive media emphasis on boosting dietary calcium intake, it’s not surprising that one of our most common mineral deficiencies escapes unnoticed. Australian studies found the daily intake of magnesium to be below the RDI for 50% of males tested, and 39% of women. Magnesium is found in grains and vegetables (and dairy products), but only when they are grown in magnesium rich soils. Depleted soils, combined with food processing and a low intake of leafy green vegetables leads to magnesium deficiency. Then there’s the magnesium depleting effects of the nightly glasses of wine, sipped to calm jangled nerves. Stress stimulates the production of stress hormones which increase the amount of magnesium we flush down the toilet every time we pass water. In a “catch-22” cycle, the resulting magnesium deficiency then causes an exaggerated release of these same stress hormones. Have you ever sat in front of your computer screen and noticed an annoying rapidly twitching muscles in your eye lid? Or woken at night with a leg in the vice like grip of cramp? Other symptoms of low magnesium levels include depression, anxiety, restlessness, irritability, PMS, menstrual cramps and insomnia.
While magnesium supplements have been shown to decrease anxiety and depression, the results are even more dramatic when combined with B complex nutrients, especially vitamins B6 and folate. Boosting B vitamins can have a direct effect on the availability of important neurotransmitters in the brain, such as serotonin, norephinephrine and dopamine – the brain chemicals involved with regulation of mood.
5-HTP and SAM-e are two of the supplements supreme when it comes to the nutritional treatment of depression and anxiety. 5-HTP is a natural derivative from an amino acid, and is a metabolic precursor to the neurotransmitter serotonin, vital for normal mood regulation. Some studies have shown 50mg a day of 5-HTP to be as effective or better than the SSRI antidepressant Fluoxatine, with no negative side effects. 5-HTP works like SSRI drugs which increase the availability of serotonin in the junctions between brain neurons, by blocking the cell’s re-uptake. Unlike SSRI’s 5-HTP also increases the availability of norepinephrine, which increases energy and alertness and dopamine, which increases the feelings of wellbeing.
SAM-e or S-adenosylmethionine is a molecule found naturally occurring in the body, but notably lower in people suffering from mood disorders. There have been 40 mostly European studies involving 1400 depressed patients, that generally show SAM-e to elevate mood within a matter of days, with virtually no side effects. The typical supplemental dose is 400mg twice daily, which has been increased to 1600mg a day in a number of studies. A 1994 analysis of existing studies, done at the University of Rome concluded “the efficacy of SAM-e in treating depressive syndromes and disorders is superior to that of placebo and comparable to that of standard tricyclic antidepressants. Since SAM-e is a naturally occurring compound with relatively few side-effects, it is a potentially important treatment for depression”.
A final note of caution. If you are already taking antidepressant drugs do not stop or change your medication without medical supervision. To obtain maximum benefit from clinical nutrition in the treatment of anxiety or depression, work with a health professional trained in clinical nutrition.