Depression
Depression can present in many ways. You might feel that you lack of energy or motivation. Sometimes it is just the sense of feeling sad more often than not. Other times, it could be unexplained body aches or trouble sleeping. Point is, you don’t feel great and would like to get better. You’ve identified a problem, but you are not sure how to fix it.
The first thing you should know is that it is not all in your head. There is a tendency to think that mental health issues are purely with the brain, losing sight of the fact it is connected to a body. There are medical conditions that can present with symptoms of depressed mood. You want to check for those factors and not just focus on the head.
There is more to treating depression than getting medications. You have to take care of your general health too. There’s this assumption that people in the U.S. are getting a balanced diet and have all of the nourishment they need. That is not always the case. Especially for people dealing with mental health issues. I digress… The typical medications used to treat depression are selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). Those medications do as their names suggest, they inhibit the reuptake of serotonin and/or norepinephrine. Let’s take a step back to understand what’s going on and why this is important.
Nutrition:
Your body makes serotonin from Trytophan in your diet. There are several steps in the process starting with L-Tryptophan hydroxylase. That enzyme requires:
Vitamin D
Vitamin B6 (P5P)
Iron
BH4 (Tetrahydrobiopterine)
That gets us to 5-Hydroxytryptophan (5-HTP) which is then converted serotonin (5-HT) by the enzyme Aromatic Amino Acid Decarboxylase. That enzyme requires:
Vitamin B6 (P5P)
After the serotonin is made, it is stored in these tiny containers in the cells called vesicles. Those vesicles will dump that serotonin out on demand and activate serotonin receptors. The body then does one of three things with the serotonin. It either:
Degrades the serotonin
Recycles the serotonin
Converts serotonin into melatonin
The degrading (i.e., breaking down) is done by the MAO enzyme. The recycling is done by these pumps, that suck the serotonin back into the vesicles. Those pumps are the “Reuptake” process that the SSRIs and SNRIs are blocking. The effect is to increase the level of serotonin that is around to activate the serotonin receptors. This action then alleviates the symptoms of depression for many people.
Here is that part that’s really interesting. We make an assumption that the body is able to make serotonin. This pump inhibition is taking effect after the body has manufactured, packaged and released the serotonin. After all of that work, the medication is able to increase the level. Well what do you think happens in people who are deficient in Vitamin D, B6, BH4, Iron. Might they be deficient in the production of serotonin? I’m not sure if anyone knows for sure, but I do know that deficiencies in any of those vitamins have signs and symptoms of depression.
The key idea is in psychiatry, you cannot take people’s health status for granted. That’s the point of taking an integrated approach to treating depression. Not only should you consider taking that SSRI or SNRI, but you should also be sure to have your Vitamin D replenished if it is low. When you look at the biochemistry, these ideas are self evident and the approach makes sense.
Bipolar Disorder:
A few other key things you should know about depression is that it can sometimes be bipolar disorder. The “bi” in “bipolar” disorder stands for the notion of two poles: one of depression and another one of mania or hypomania. People with “unipolar depression” aka “depression” are the ones who do well with antidepressant medications. People with “bipolar” disorder are better off with mood stabilizers vs. antidepressants.
Thyroid Diseases:
The thyroid gland is located in your neck, around your throat. It produces hormones that float around your body and control your energy level. Most of the thyroid hormone floats around as Thyroxine (T4) and requires:
Iodine
T4 gets converted to Triiodothyronine (T3) by deiodinases, which is much more potent, in terms of increasing your energy levels. The conversion of T4 to T3 requires:
Selenium
Low levels of T4 and T3 can have signs and symptoms consistent with depression and even dementia. People with diets deficient with iodine and/or selenium could have signs and symptoms consistent with dementia.
Cholesterol:
Low levels of pregnenolone is associated with depressed mood.
Conclusion:
Medication is really helpful for treating signs and symptoms of depression. There are vitamin deficiencies and diseases that can present as depression. In treating your depression, you want to be sure you have been properly screen for these different issues. Taking this multifaceted approach is a powerful way to address your mood issues to help you feel better sooner.
Future sections to add:
Lithium
BDNF and exercise
Stress, Cortisol and Adrenals
Gut
Inflammation
