Depression

What is depression?

Depression is a mental health disorder which affects the brain and causes dysfunction with mood, thoughts and feelings. Depression can seriously impact a person’s ability to have a good quality of life, as it causes a number of symptoms which cause the person to isolate themselves from the world around them.

Depression is not a passing low mood, nor is it a sign of weakness, or an inability to cope. People who are depressed cannot just “snap out of it”, as it isn’t a normal low mood (which everyone experiences from time to time), it can be a serious disorder which is characterised by a number of symptoms, many of which are serious and can be life threatening (suicide) if not diagnosed and treated early.

Depression is one of the most common disorders that brings people to see a doctor. Depression can be triggered by a stressful event or it can be due to some type of imbalance in the brain’s chemistry.

There are a few different forms of depression:

• Bipolar affective disorder – this type of depression is characterised by alternating depressive and euphoric episodes, which can change without any warning. Bipolar disorder causes severe mood swings. Bipolar disorder was previously known as manic depressive disorder
• Dysthmia – this type of depression has symptoms which lie somewhere between reactive depression and major depressive disorder. It has less symptoms with less duration than major depressive disorder, but it is not as mild as reactive depression. Dysthmia is generally not biological in origin (unlike major depressive disorder)
• Major depressive disorder – this type of depression is characterised by major depressive episodes, which occur more frequently and more severely than just feeling depressed due to a reaction to a stressful event in life. This type of depression is commonly genetic in origin and causes depression symptoms even without any stressful life events
• Post-partum depression – this type of depression affects women directly after giving birth and is characterised by an inability to bond with the baby, as well as other debilitating symptoms. Post-partum depression can be severe and requires medical intervention to prevent serious complications for both mother and baby
• Reactive depression – this type of depression is characterised by having a strong reaction to a stressful event(s) in life (such as losing a job or ending a long term relationship). While this type of depression has few or mild symptoms, it can become quite intense, so it should treated appropriately to prevent complications (such as suicide). This depression is also known as adjustment disorder with depressed mood and is the most common type of depression

Facts about depression

• Many people (5-10% of the population) experience major depression at any given point in time
• Around 15-20% of all people will develop some form of depression in their life. This is approximately 1 in 5 people who will feel depressed at some point in their life
• Depression may occur due to a reaction to an intensely stressful situation(s) in life, which is the most common form of depression
• The tendency to develop major depression is an inherited disorder, which means that there may be a genetic component to it
• People who are depressed tend not to seek treatment
• Sixty percent of cases of clinical depression are considered to be treatment-resistant depression
• There are several different types of depression, which are characterised by the different symptoms that are present with each condition
• Depression is a real illness which can impact a number of areas in a person’s life
• Men tend not to see their doctor (compared to women) about feelings of depression, as they seem to see it as a sign of weakness and an inability to cope with their life
• Feeling low, blue or sad after a particularly stressful event is normal, it is only when that low mood continues and is accompanied by other symptoms when depression can be diagnosed
• Some forms of depression are due to dysfunction in the chemicals (neurotransmitters and other substances) in the brain and this form of depression is hard to predict
• Depression can co-exist with a number of other disorders, which may precede the depression, trigger it, or be a consequence of it
• Alcohol and substance abuse often co-exist with depression
• Depressive illness is a disorder of the brain
• Studies of people with depression show their brains look different than people without depression
• People with depression have unbalanced levels of a number of important neurotransmitters, which regulate mood, thinking, sleep, appetite and behavior

Symptoms of depression

The symptoms of depression are varied and many and are classed as physical, emotional and mental symptoms, as the body, thoughts and feelings are affected:

Emotional symptoms

• Crying and feeling sad for no reason
• Feeling angrier than normal
• Feeling down, sad or depressed
• Feeling generally guilty (not related to anything specific)
• Feeling less hopeful than usual
• Feeling less loving to your family and friends
• Feeling more anxious than usual
• Feeling very helpless and not in control
• Feeling suicidal
• Losing the will to live
• Unable to feel much pleasure in anything
• Worrying more than normal

Mental (thought) symptoms

• Avoiding other people, isolating yourself
• Concentration levels decline
• Difficulty making any decisions
• Less optimistic than usual (more pessimistic)
• Lowered self-esteem
• Not as interested in your normal activities
• Thinking about death a lot

Physical symptoms

• Appetite changes – either eating more or less than normal
• Less interest in normal activities
• Lowered energy levels
• Lowered libido, less interested in sex
• Sleeping less or more than what was normal previously
• Symptoms are worse at certain parts of the day

Causes of depression

The cause of depression is not known. It is thought to be due to a combination of a number of different factors.

Biochemical

The neurotransmitters in the brain control mood, thinking, sleep, appetite and behaviour and if these neurotransmitters become unbalanced, depression can be the result. The main neurotransmitters affected are: serotonin, dopamine, GABA, but there are many others which play a part in the brain’s function.

Environmental

The most common reason for depression is experiencing a stressful life event, such as the loss of a loved one, divorce, break-up, losing a job, trauma. Even positive events can cause depression, if they are significant enough – getting married, buying a home for the first time, having a baby, promotion or getting a huge pay rise.

Genetic

Researchers have determined that some types of depression tends to run in families, which suggests that in these people, there is a genetic link which has been a factor in causing the depression, but this genetic link is not the sole factor.

Research into the genetic cause of depression suggests that people who have certain genes that are a risk factor for depression will develop it, if there are environmental or other factors which trigger the genes to cause depression to start.

Psychological

Some people seem to have a more negative or pessimistic view on life, so when stressful events occur, this may trigger depression, from a mild case, to a more severe one.

Prevention of depression

Non-preventable risk factors

Depression may be unpreventable in certain circumstances:

• Genetics – some forms of depression seem to have a genetic link (due to a number of linked genes), which means certain family members will be affected by depression. Even though there is a genetic link, researchers think that the faulty genes need to be triggered by either an external event (environmental factor) or another factor to cause the depression to start. Just having the faulty genes does not seem to be enough in most cases to cause the depression
• Illness – certain illnesses, especially if they are serious and life threatening, are associated with a risk of triggering depression in some people. The illnesses most associated with depression are: AIDS/HIV, cancers, Alzheimer’s disease, heart disease and all forms of degenerative conditions (fibromyalgia, etc). Serious illness is a potential major stressful situation, which is a trigger for depression in some people
• Neurotransmitter problems – if the neurotransmitters in the brain are not in proper balance, this means the brain chemistry is not healthy and normal, which could lead to depression. The main neurotransmitter which is affected is serotonin, which is normally too low in people with depression. Serotonin is responsible for regulating mood, as well as appetite and sleep. It is not known at present what causes the serotonin levels to drop in people with depression
• Low levels of serotonin – people who have depression tend to have much lower levels of the neurotransmitter serotonin, which is important as it regulates mood, appetite and sleep. In fact, many anti-depressant medications work on keeping serotonin at a certain level, to reduce depression symptoms
• Long term use of certain medications – people who use certain medications over a long term, may be more likely to develop depression as the medications may cause depression as a side effect, or trigger it, due to biochemical changes in the brain. The medications most likely to trigger depression are: sedatives (sleeping pills), blood pressure medications and sometimes even the contraceptive pill (although this is quite uncommon)
• Low self-esteem – people who have low self esteem may be a higher risk for depression because their self-talk tends to be more negative, self-critical and pessimistic, which only serves to make them feel even more unhappy about themselves, so they may be prone to become more depressed or have depressive episodes than people who feel okay about themselves. Researchers are not sure what the reason behind this is, but they think it could be that the constant negative thinking causes imbalances in the brain chemistry or other problems in the neurons or pathways in the brain which make it more likely that depression develops
• Low socioeconomic background – research suggests that people from a low socioeconomic background are more likely to develop depression. This may most likely be due to the conditions of their existence (poor quality of life)
• Stressful events – stressful events, especially if they are major can precipitate depression, irrespective of whether the event is a positive one (marriage, new baby, new house, promotion at work) or a negative one (death of a loved one, marriage break up, separation, illness). Stressful events do not affect everyone in the same way, because everyone’s brain chemistry, outlook on life and past history are different

Preventable risk factors

There may be ways to prevent depression from occurring or reduce severity and duration of symptoms:

• Early recognition of symptoms – depression is a really treatable condition especially when symptoms have just started and are quite mild and not too severe. It is advisable to understand the symptoms of depression so that if you feel that you may be experiencing them you see your doctor to be properly diagnosed and to be given advice on the best treatment options, which may allay worsening of symptoms (which can be quite debilitating) and any possible complications. You can even discuss alternative options to medication with your doctor at this stage, as early symptoms of depression tend to respond quite well to alternative/complementary treatment options
• Healthy diet – if a person eats foods that are in the recommended diet guidelines, this may help prevent depression in some cases by providing the nutrients which are required to synthesise the important neurotransmitters (serotonin, dopamine, GABA) which are responsible for regulating mood, appetite, sleep and other functions. If these neurotransmitters are unbalanced, or too low, depression can be the result. While in some people this may be genetic, for the majority, it is not, so a healthy diet may prevent imbalances in the neurotransmitters and ultimately may prevent depression (or at least may prevent it from being severe)
• Negative or pessimistic outlook – research shows that people who have a negative or pessimistic outlook on life, tend to be more depressed, or more prone to episodes of depression. Researchers are not sure what the reason behind this is, but they think it could be that the constant negative thinking causes imbalances in the brain chemistry or other problems in the neurons or pathways in the brain which make it more likely that depression develops
• Social interactions – social isolation, loneliness and being away from other people is one factor which may lead to depression in some people. Try to ensure that you have regular contact with your friends and participate in activities that are fun and enjoyable, to help prevent one factor that may lead to depression
• Regular exercise – regular exercise help to reduce the stress hormones (adrenaline, noradrenaline), increases the levels of the “happy hormones”, endorphins, which increase pain threshold and create a better mood. Regular exercise may help to prevent depression, or worsening of symptoms in some people

Complications of depression

There are some significant complications of depression, especially if it has not been diagnosed, or it continues unabated and untreated:

• Alcohol (or other substance) abuse – people who abuse alcohol (or other substances) tend to be depressed. The depression can cause some people to turn to alcohol (or other substances) to try to numb their pain and other symptoms. Unfortunately, abusing alcohol (or other substances) will only lead to a number of other health problems, which only become more adverse with the longer the excessive drinking continues
• Anxiety – depression and anxiety go hand-in-hand usually, with one precipitating the other. People with depression, who do not also have some type of anxiety disorder, tend to develop it during the course of their depressive episodes, especially if the depression continues over a long term without proper treatment
• Heart disease – some recent research showing a link between depression and heart disease development. The research suggests that depression that is untreated, continues for a long time or does not respond well to treatment, is linked to heart disease developing, especially life threatening arrhythmia. Other research shows that people who have depression and heart disease, have a poorer prognosis of both their conditions and respond much less positively to their medication
• Relationship problems – people who are depressed may have major relationship problems with their family, their partner, children or friends, due to their symptoms. Depression causes people to isolate themselves from others, so loved one may not understand why they are being cut off from the depressed person’s life, additional, depression makes it hard for the depressed person to relate in a healthy way with other people and this can potentially cause a great deal of conflict in the person’s relationships. Conversely, relationship problems can cause depression in some people, so the continuation of the relationship problems in someone who is depressed may further exacerbate their symptoms, creating a vicious cycle that continues seemingly unabated
• Social isolation – people who are depressed tend to feel alone, they tend to isolate themselves from their family, friends and loved ones, which only makes them more socially isolated and much less likely to reach out to make connections with people. The social isolation only further serves to exacerbate the symptoms of depression (feeling more lonely) and can increase the severity of symptoms
• Suicide – the ultimate adverse complication of depression is suicide, taking one’s life because the pain inside is too hard to bear. Anyone who attempts suicide is crying out for some help, because they may be overwhelmed with all the symptoms of depression, which can be quite awful and adversely impacts so much on life, reducing quality of life, when it is severe

People who feel so down that they are having thoughts of taking their life should call Lifeline on – 131114.

When to see a doctor about depression

People who are experiencing any of the symptoms of depression, especially if they continue for a number of weeks, months or years, need to see their doctor to be diagnosed and to be advised of treatment options.

You need to understand that you are not weak or less of a person because you are seeking treatment for depression. You are actually being strong and smart and taking care of your health.

While it is normal to feel sad and upset at the stressful or negative events in life, it is not normal for these feelings to continue or to have these feelings impair you in any way or cause you to start to behave differently, in a way that reduces your quality of life.

Depression, even the most severe cases, is a highly treatable disorder. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that recurrence can be prevented.

Suicidal thoughts are normal in people with depression, just as long as you do not do anything about it.

People who feel so down that they are having thoughts of taking their life should call Lifeline on – 131114

People with existing depression need to see their doctor on a regular basis, to monitor their treatment, to discuss any side effects to medication, to adjust their medication and to discuss any other alternative/complementary treatment options (instead of medications). People who are taking any type of medication should not try alternative/complementary treatments without discussing them with their doctor, as the combination may have a very serious outcome, that could even be dangerous.

Suicidal thoughts are normal in people with depression, just as long as you do not do anything about it.

Diagnosis of depression

Initial diagnosis of depression is conducted through the following tests:

• Medical history – you doctor will ask a series of questions about the history of the symptoms, including the severity, duration of symptoms, as well as the exact date they started and if anything unusual or stressful occurred prior to the onset of the symptoms
• Physical examination – your doctor will perform a physical examination of your eyes, ears, lungs and heart, to check your overall health

Since depression could be due to a number of other illness (or can be exacerbated by any number of other illnesses), your doctor may do the following tests to rule them out:

• Blood test – a blood test is usually requested to rule out the following conditions:
  • Low blood sugar levels – the condition hypoglycaemia can cause depression-like symptoms, due to the lowered blood glucose levels
  • Low iron levels – if there are lowered blood levels of iron or haemoglobin, this can also present with depression-like symptoms
  • Thyroid disorder – in particular, hypothyroidism, which may cause depression as one of the symptoms
• CT scan – a CT scan can be requested if your doctor suspects an underlying problem with the brain, in particular to rule out brain tumour as the cause of the depression symptoms, especially if other symptoms point to this condition

If the initial diagnosis and blood test rule out any other disorders, then the following further tests may also be requested, to properly diagnose and confirm depression:

• Psychological evaluation – your doctor may request you undergo psychological evaluation of your symptoms to determine (a) the type of depressive illness you are experiencing, (b) the treatment options recommended and (c) the possible duration of symptoms

The doctor, psychologist or psychiatrist will use certain diagnostic criteria to diagnose depression in the psychological evaluation.

These criteria include the following symptoms:

• Agitation or restlessness
• Difficulty concentrating, making decisions or thinking properly
• Fatigue or lacking in energy
• Feeling worthless or guilty, for no apparent reason
• Loss of interest or pleasure in most activities
• Symptoms that cause distress or impair ability to function in daily life
• Symptoms that have been present for most days in a period of 2-3 weeks
• Thoughts of death or suicide
• Weight gain or weight loss that was unintentional

Conventional treatment of depression

Treatment may include a combination of medication, individual therapy and community support. Some medical experts believe that electroconvulsive therapy (ECT) can be helpful for depression that has been unresponsive to any type of medication therapy.

The conventional treatment of depression depends on the severity of the symptoms.

Treatment for mild depression

Mild depression is often only treated with the following therapies (medication is not normally given for people with mild depression that has not occurred previously):

• Counselling – your doctor may recommend you engage in some counselling with a qualified psychologist or psychiatrist and depending on your income level, Medicare (in Australia) covers a proportion of the costs of counselling for a specific number of counselling sessions
• Online Cognitive Behavioural Therapy (CBT) course – CBT helps you lean to think differently, in a less negative way about yourself and your life. CBT teaches that negative thinking can be a “bad habit” that needs to be untaught. The Australian National University provides an excellent and free CBT course for people who suffer from mild to moderate depression
• More exercise – your doctor may recommend you engage in more exercise each day (depending on your fitness level and health) as exercise can help reduce feelings of depression more quickly than other therapies and is especially beneficial for people with mild depression
• Self Help Books – your doctor may recommend a self help book on depression to provide more in-depth strategies for reducing symptoms

Treatment for moderate depression

Moderate depression is often treated with the following therapies, either independently or in combination, based depending on diagnosis of symptoms:

• Medication – your doctor may try to prescribe some form of anti-depressant medication for your symptoms depending on the severity and duration. The most commonly prescribed anti-depressant medications are:
  • Benzodiazepines – these drugs have a mild tranquillising effect, which is why they are often prescribed for people with depression and who have severe insomnia associated with their condition. Benzodiazepines also help to reduce anxiety associated with depression. Benzodiazepines are prescribed at a low and regular dose, but only for a short period. This class of drugs have relatively few side effects (compared with some other types of medications) other than rebound wakefulness in some people, but if taken long term, they can become highly addictive. People who become addicted to benzodiazepines become dependent on them just to feel normal and without taking this drug, they often feel worse than they did prior to when they starting to take it. Examples of benzodiazepines: Lorazepan (Ativan^®), Chlordiazepoxide (Librium^®), Oxazepam (Oxazepam^®), Diazepam (Valium^®), Alprazolam (Xanax^®)
  • Monoamine Oxidase Inhibitors (MAOI) – these medications are the oldest class of anti-depressant medications and they should not be taken in combination with any type of SSRI drugs or St John’s Wort as the combination can produce serious (and fatal) side effects. MAOIs can produce serious side effects and their use must be strictly monitored to prevent this from occurring. People are often prescribed MAOIs when other types of anti-depressants have not worked to reduce symptoms. MAOI are the least often prescribed anti-depressants as they have such a large range of side effects and a restrictive diet needs to be followed when taking them. Examples of MAOIs are: Phenelzine (Nardil^®), Tranylcypromine (Parnate^®), Isocarboxazid (Marplan^®),
    People taking MAOIs should avoid the following food (to reduce possible adverse effects):
    • Alcohol
    • Avocados
    • Broad beans
    • Cheese (any type)
    • Fermented soy extract
    • Salami
    • Meat or yeast extract
    • Pickled herring
    • Food that is stale or going off, especially meat, fish, offal, poultry or game
  • Mood stabilisers – these medications are normally prescribed for people with depression in bipolar disorder to help reduce symptoms. Examples of mood stabilisers are: Valproate (Epilim^®), Valproate Semisodium (Depakote^®), Carbamazepine (Tegretrol^®)
  • Selective Serotonin Reuptake Inhibitors (SSRIs) – these drugs are a newer class of anti-depressant medications which alter the levels of serotonin in the brain (they increase the levels of serotonin to control mood) and to reduce low mood symptoms. SSRIs were a recent anti-depressant medication development, only available from around 30 years ago. These drugs can also produce side effects but these are usually milder in comparison to older antidepressants (MAOI) and side effects normally decrease after some time, for most people. Examples of SSRIs are: Citalopram (Cipramil^®), Fluvoxamine (Faverin^®), Paroxetine (Seroxat^®), Fluoxetine (Prozac^®), Sertraline (Lustral^®).
    SSRI should not be taken in combination with St John’s Wort, or any other type of anti-depressants, or MAOI as they can cause a fatal reaction
  • Tranquilisers – these drugs are another classes of tranquilisers that can be prescribed (which are different to benzodiazepines) that can reduce anxiety symptoms associated with depression very quickly. Some of these different types of tranquilisers may also have fever side effects than benzodiazepines. These tranquilisers are best when used over a short-term, should not be used with MAOIs and should not be used with alcohol. Examples of other tranquilisers are: Buspirone (Buspar^®), Hydroxyzine
  • Tricyclics – these drugs are an older type of anti-depressant medication which work as well as SSRIs for reducing symptoms of depression. Tricyclics help to increase levels of serotonin and norepinephrine which help to stabilise the mood. These drugs have some side effects which can usually be reduced by lowering the dose or changing to another type of tricyclic medication, but even despite this, a great number of people abandon this medication due to the side effects that they produce. Examples of tricyclics: Amitriptyline (Triptafen^®), Clomipramine (Anafranil^®), Dosulepin/Dothiepin (Prothiaden^®), Doxepin (Sinequan^®), Imipramine (Tofranil^®), Nortriptyline (Motival^®)
• Psychotherapy – this involves any or all of the following treatment options which can be provided by a psychologist, psychiatrist, or qualified counsellor, or through self-help means:
  • Cognitive Behavioural Therapy (CBT) – CBT helps you lean to think differently, in a less negative way about yourself and your life. CBT teaches that negative thinking and even depression can be a “bad habit” that need to be untaught
  • Mindfulness and acceptance – mindfulness acceptance therapy is about being present in the moment and relishing it for what it is without stressing about the past or the future. Mindfulness is about allowing yourself to experience a situation and to observe how it makes you feel without judgement, without worry and without negative thinking. It is one way to help accept yourself and be less negative
  • Online CBT Therapy – the Australian National University provides an excellent and free CBT course for people who suffer from mild to moderate depression
  • Self help books – another useful strategy for people with mild to moderate depression is to use self-help books by qualified authors who can provide detailed advice on how to conquer the symptoms of depression step-by-step, usually through some form of CBT or mindfulness therapy

Treatment for severe (major) depression

People with severe (or major) depression will be offered the same medications as people with moderate depression (above), but at higher doses.

People with really severe depression that has not responded to any form of medication or other therapy can also be offered electroconvulsive therapy (ECT).

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a procedure where the person’s brain is hooked up to electric wiring and a level of electric currents is passed through the wires to the brain. This form of “electric shock” therapy will cause a brief seizure, which also causes some changes in the brain chemistry. The person will be anaesthetised first, to prevent any pain from this procedure before the electric current is allowed to pass through the brain. ECT normally occurs over two to three treatments (sometimes more for really severe cases).

Proponents of ECT suggest that it helps to alleviate symptoms of certain mental illness in people, as it uses precisely calculated electrical currents that are administered carefully by specialists and aims to provide benefits with little risk.

Despite this, ECT remains a very very controversial therapy, even since it was introduced over 70 years ago as there are a number of possible side effects and risks following the procedure, including:

• Cognitive impairment – straight after an ECT treatment people experience confusion in the though processes, they wont know where they are, or why they are there. This cognitive impairment last seconds to minutes after the ECT procedure but usually goes away after ECT treatment has been totally completed
• Medical complications – in any procedure where anaesthesia is used, there is a small risk of death and prior to the ECT there are a number of tests that are performed to determine eligibility for this procedure
• Memory loss – ECT can cause memory loss, ranging from inability to remember events (from weeks to months) leading up to the procedure, to inability to recall events after the procedure and for a very rare few, these memory loses are permanent
• Physical pain – many people experience a range of physical problems after the procedure, including nausea, vomiting, headache, muscle ache or jaw pain

The depressed people who are in any of the following groups only are offered electroconvulsive therapy (ECT):

• People who are severely depressed and have major psychosis
• People who are severely depressed and are suicidal or refuse to eat at all
• People who are severely depressed, have bipolar disorder and whose mania hasn’t improved with any type of medication or other treatment

Alternative / complementary treatment of depression

Alternative / complementary medicine treats not just the symptoms of depression, but the underlying cause.

People who are taking any type of medications for their depression should not try any of these herbal treatments especially, but also not any of the other supplements without first consulting their doctor, as the results of the combination could be life threatening.

Herbs

There are a number of herbs which can help to reduce symptoms:

• Ginkgo (ginkgo biloba) – the herb ginkgo biloba helps to stimulate circulation to be normal and it protects the nerves against damage, plus it also has anti-depressant activity, so it may be a useful adjunct in alternative/complementary therapy for depression
• Schisandra (schisandra chinensis) – the herb schisandra has been used in Chinese medicine as a nerve tonic to help improve memory and mental performance and Chinese medicine practitioners use it together with other herbs and supplements to help relieve symptoms of depression
• St John’s Wort (hypericum perforatum) – a number of studies have shown that hypericum perforatum was safe and more effective than a placebo in the treatment of mild to moderate major depression. Other studies have shown that hypericum perforatum was just as effective, but better tolerated than a particular anti-depressant (paroxetine) in the treatment of moderate to severe major depression. A recent scientific review of anti-depressants has suggested that anti-depressants are not effective in any type of depression other than severe major depression. Note: never take St John’s Wort if you are also taking any type of anti-depressant medications
• Vervain (verbena officinalis) – the herb vervain has been traditionally used to treat depression, by reducing the mood problems associated with depression. One animal study showed that vervain had some sedative effects, but more studies are needed to confirm this one study. Consult with your doctor if you want to try vervain, never self-prescribe any herb, particularly if you are already taking anti-depressants or any other medications

Vitamins

There are a number of vitamins which are especially useful to help reduce symptoms associated with depression:

• Folic acid – in numerous studies of people who were depressed, around 35% had a folic acid deficiency and in depressed older people this deficiency is even higher (up to 96%). Depression is the most common symptoms of a folic acid deficiency and supplementation normally improves symptoms dramatically. Only a blood test can determine if there is a folic acid deficiency
• Vitamin B1 (thiamin) – vitamin B1 (thiamin) is one of the vitamins that is important for a healthy functioning nervous system. Any mild deficiency in this vitamin may exacerbate depression symptoms
• Vitamin B2 (riboflavin) – vitamin B2 (riboflavin) is one of the vitamins that is important for a healthy functioning nervous system. Any mild deficiency in this vitamin may exacerbate depression symptoms
• Vitamin B3 (niacin) – vitamin B3 (niacin) is one of the vitamins that is important for a healthy functioning nervous system. Any mild deficiency in this vitamin may exacerbate depression symptoms
• Vitamin B5 (pantothenic acid) – vitamin B5 (pantothenic acid) is one of the vitamins that is important for a healthy functioning nervous system. Any mild deficiency in this vitamin may exacerbate depression symptoms
• Vitamin B6 (pyridoxine) – studies show that many people with depression have lowered levels of this B vitamin, especially women who are also taking the contraceptive pill. Vitamin B6 (pyridoxine) is involved in the synthesis of serotonin, the neurotransmitter responsible for regulating mood, so supplementation may be required if there is a deficiency. Only a blood test can determine if there is a vitamin B6 (pyridoxine) deficiency
• Vitamin B12 (cyanocobalamin) – many studies show that while it may be less common, a deficiency in vitamin B12 (cyanocobalamin) can cause symptoms of depression and that symptoms improve dramatically with supplementation. Only a blood test can determine if there is a vitamin B12 (cyanocobalamin) deficiency
• Vitamin C – some of the symptoms of vitamin C deficiency are depression and lethargy and while most people will get enough vitamin C in their diet, some people may have a mild deficiency (especially older people, people who do not eat enough food or people with certain health conditions). Only a blood test can confirm if there is a vitamin C deficiency, even a mild/borderline one
• Vitamin E – the antioxidant vitamin E is necessary for good circulation and proper functioning of the immune system and all the cells. Vitamin E is also required to improve the level of oestrogen in

Minerals

There are a number of minerals which are especially useful to help reduce symptoms associated with depression:

• Calcium – several studies show that people with depression have lowered calcium levels and that supplementation helps to improve symptoms. Women seem to be more affected by the low calcium levels, especially women of child-bearing years who may also have severe PMS (or PMDD) symptoms due to the calcium deficiency. A blood test can confirm a calcium deficiency
• Magnesium – the mineral magnesium is important for people with depression as it helps to relax smooth muscle tissue in the body and induces a sense of calmness and relaxation. There may be a deficiency of magnesium in some people with depression and in fact several studies have shown that people who have depression tend to have lowered levels of magnesium when they are going through a depressive episode. A blood test can confirm a magnesium deficiency
• Selenium – a deficiency in the antioxidant mineral selenium is though to be linked to depression and other low mood states. Studies show that people who have a mild selenium deficiency that is the cause of their depression symptoms receive the most benefit from supplementation. Only a blood test can determine if there is a selenium deficiency
• Zinc – a deficiency in the antioxidant mineral zinc can present with lethargy, depression and anxiety symptoms, as well as impaired immune system function (frequent infections), which means zinc is very important to good mental function and mood. Studies have shown that people with depression tend to have low levels of zinc and supplementation tends to improve symptoms without any of the side effects associated with anti-depressant medications. It is important to determine if zinc deficiency is the cause of depression and low mood symptoms

Other nutrients

There are a number of other nutrients which are especially useful to help reduce symptoms associated with depression:

• GABA – the amino acid GABA is used by the body to produce a neurotransmitter that relaxes and calms the mind and balances the mood
• Omega-3 fatty acids – there is some evidence that the omega 3 fatty acids may help with people who have depression, as they are necessary to ensure the membranes on the nerve cells are healthy and function properly. Since depression may be due to imbalanced brain chemistry, it could be useful to ensure omega-3 fatty acids are topped up either in supplements, or by eating more oily fish (mackerel, salmon, sardines, trout, tuna) about 2-3 times a week
• Phenylalanine – the essential amino acid phenylalanine is important as it is a precursor to enable the synthesis of noradrenaline and adrenaline, the two neurohormones which are required to allow the body to better deal with stress and tension, which may be deficient in people with depression
• SAMe – the substance S-adenosylmethionine is a naturally occurring molecule in the body which has been successfully used to help reduce low mood and anxiety symptoms that people with depression normally experience. SAMe is a precursor of the very important neurotransmitter serotonin, which is implicated in many mood disorders when it is at levels that are too low
• Tryptophan – the amino acid tryptophan is a precursor to the important neurotransmitter serotonin, which regulates mood and helps ensure feelings are more balanced and calm, so it is used to help reduce anxiety and depression symptoms. Foods rich in tryptophan, include bananas, warm milk and turkey. To help with sleep, try some warm milk with honey about 30-60 minutes before bed

Dietary modifications

There are a number of dietary modifications which are especially useful to help reduce symptoms associated with depression:

• Add linseed oil or cod liver oil to the diet – both linseed oil and cod liver oil contain vital essential fatty acids (omega-3), which are beneficial for normal brain health. People taking any type of medication for their depressive disorder should consult their doctor before trying either of these natural oils, to avoid possible adverse effects
• Avoid alcohol and drugs – while it may feel that alcohol and some types of drugs help to relax you and make the symptoms go away for a little while, they are just numbing the depression and make the problems worse in the long run
• Avoid sugar and all refined foods – this is because high intakes of sugar and highly processed (take-away, junk) foods may cause a rapid rise in blood glucose levels and then another rapid fall (just soon after), which may interrupt the body so much that it can cause anxiety and depression if the blood sugar levels are not quickly increased again. This not only affects low mood, but can cause weight gain, which may further increase depression
• Certain foods induce calm – studies show that certain foods can create a more calmer mind and body, due to the nutrients they contain. The foods most recommended for a calmer and less anxious state are: asparagus, avocado, beetroot, carrots, eggs, oily fish, onions, paw paw, spinach, stone fruit
• Certain foods increase serotonin – food that are high in the amino acid tryptophan help to increase the levels of serotonin in the brain, which is one of the neurotransmitters associated with risk for depression. Foods rich in tryptophan are: turkey, chicken, soy beans, tuna, mozzarella cheese, milk
• Eat more egg yolks – organic egg yolks (about one per day) is highly recommended to increase intake of lecithin (phosphatidyl choline). Many studies show that lecithin helps the brain neurons and in particular, the dopamine neurotransmitters, function more effectively, which may help reduce symptoms in people with depression

Lifestyle modifications

There are a number of lifestyle modifications which are especially useful to help reduce symptoms associated with depression:

• Cognitive behavioural therapy (CBT) – this therapy is used by many clinical psychologists, psychiatrists and counsellors to help people with depression understand, manage and change their thoughts and behaviours. Many studies show that CBT is just as effective as using only anti-depressant medications. CBT works by helping to identify and change negative thinking associated with depressed feelings, focusing on positive things and managing problems in life
• Exercise – studies have shown that regular exercise is often as effective as medication (anti-depressants such as selective serotonin re-uptake inhibitors SSRIs) and people engage in physical activity report less symptoms of depression than the control group (who did not engage in any exercise or take any medication). Aim to engage in about 30-45 minutes of exercise most days, some of which should be cardiovascular and some resistance training
• Mindfulness therapy – a newer form of psychotherapy is mindfulness, which aims to prevent relapse and assist with regulating mood by aiming to create more focus and self-awareness. Mindfulness is about becoming aware in the present moment without any judgement on whether it is “good” or “bad”, instead just to “be” in the moment and observe it and then let it go. Mindfulness is adapted from specific Buddhist meditation
• Relaxation techniques – it is really important to engage in some type of relaxation techniques, in order to help calm the mind, reduce negative thinking and release some of the negative emotions that are caught up in the mind. Relaxation techniques can help instill a sense of calm and feeling of contentedness Some good relaxation strategies are: mediation, tai chi and visualisation
• Regulate activities – it is important for people with depression to have regular activities planned for each day, especially if they are not working, as the lack of direction and lack of life goals could reduce motivation and cause a relapse
• Sleep – make sure you have enough sleep each night and try to go to sleep and wake up around the same time each day to get a regular sleeping pattern going, which helps set the body clock (and assists with regulating many processes in the body)
• Yoga – this is a great way to control breathing, the negative emotions and to also help control the body, which can provide more confidence and a reduction in symptoms. There are many forms of yoga, from the very vigorous to the more relaxing, meditation types

Alternative treatments

• Acupuncture – studies have shown that acupuncture may be beneficial for people with depression to help reduce symptoms and is even more significantly beneficial when it is combined with some form of psychotherapy (cognitive behavioural therapy) to reduce symptoms and help with a better quality of life
• Massage – the benefits of a relaxing massage are significant for people with depression. A therapeutic massage can relax tension in the muscles and reduce a great deal of the low mood symptoms in people with depression (but this is only temporary, a massage cannot cure the condition, but it can provide temporary relief of symptoms)
• Meditation – this is way of calming the mind and relaxing the body by using various breathing and visualisation techniques. Meditation has shown to be very beneficial in many people to combat the low mood symptoms of depression and be inducing a state of calmness and contentedness without any medication

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take BEFORE you try it.

Living with depression

There are a number of strategies which are recommended to help you better deal with depression:

• Avoid alcohol and drugs – while it may feel like alcohol or drugs take you away from your depression, they are actually a temporary crutch which hide your problems for a short while, only to come back in full force when you are dealing not only with a hang-over but your reality too. To often substance abuse and depression go hand-in-hand, so talk to someone about your reliance on alcohol or drugs, so they can help you
• Exercise – while it may be difficult to drag yourself outside (or even to get up and put in an exercise CD into the CD player), it is so beneficial for your mental health to try. So many studies show that regular exercise is often just as effective as medication for relieving depression symptoms. It would benefit you to try a little exercise each day (or at least as much as you can handle) and build up to be exercising for between 30-45 minutes each day, including some cardio and resistance training. Exercise releases endorphins, the substances which make you “feel good” and can greatly improve symptoms of depression because you feel as though you are achieving something worthwhile and not only that, exercise gives you an opportunity to stop focusing on your negative feelings
• Increase intake of nuts and seeds – especially try to eat more almonds and sunflower seeds, as they contain high levels, respectively of, magnesium/calcium and zinc, which may be lower in people with depression. All nuts and seeds are good, as they all contain some level of magnesium, calcium and zinc, plus they have excellent levels of the omega-3 fatty acids (especially walnuts and pecans), so include a large handful of raw, organic nuts and seeds into your diet every day
• Increase intake of vegetables and fruits – especially the dark green leafy vegetables (lots of folic acid and magnesium) and all the bright or dark coloured fruits (lots of antioxidants). As a lack of folic acid and magnesium are thought to cause depression symptoms, it may be really beneficial to increase intake of vegetables and fruit in the diet. Try to aim for 5-7 portions of vegetables and about 3-5 portions of fruit each day
• Limit intake of processed foods – any type of junk or processed foods will have very little nutritional value, be too high in fat, calories, sugar, salt and may make your symptoms worse. Try to limit your intake of these types of food as you will not receive much in the form of nutrients and as people who are depressed may have deficiencies in certain nutrients, you are not helping your condition to eat foods which will only exacerbate your symptoms, rather than making you feel better
• Monitor your medication side effects – if you have any side effects to the anti-depressant or other medications you are prescribed, make sure you monitor these and advise your doctor, so that he/she can either adjust your dose or prescribe a different type of medication
• Regular activities – it is important to make sure you have some order and structure in your life, without which, your depression can regress and get worse. With some regular activities planned for each day, it can help you get structure and meaning in your life, so plan what time you get up, what you will do during the day and what time you will go to bed. Write yourself a list of activities each day to aim for and don’t be too hard on yourself if you don’t achieve everything on your list; just be kind on yourself for trying
• Relaxation strategies – your doctor will have recommended this as useful for a more calmer and relaxed state of mind and to release the negative emotions, or at least to stop focusing on them and focus on something else instead, which can really give you great relief. Some good strategies for relaxation including: meditation, tai chi, visualisation and yoga
• Socialise – while it is exceeding difficult to socialise when you are depressed, you need to do the very thing that is hard for you, in order not to feel so isolated, as that can make depression symptoms worse. Even if it’s only for a short while and not on a regular basis, it is something you should try to engage in. Being around other people will give you a little more perspective and a way to distract yourself from your depression. Try it. At least once
• Talk to your doctor about nutrient deficiencies – there is a lot of evidence that depressive illness may be at least partly due to nutritional deficiencies, as low levels in a number of vitamins/minerals and other nutrients can cause depression-like symptoms associated with low mood and emotional problems. Do not try to self-prescribe as it can cause severely adverse symptoms to mix certain supplements and prescription medications

People who feel so down that they are having thoughts of taking their life should call Lifeline on – 131114

Caring for someone with depression

Partner

If you have a partner who has been diagnosed with depression, there are a number of strategies you can use to help them:

• Avoid alcohol – try not to have too much alcohol in the house, as alcohol can be detrimental to your partner’s symptoms, which may become much worse during the hangover the next day. Besides this, alcohol is only a salve that your partner uses to try to cover his/her problems and this is only going to prolong the depression
• Encourage your partner to eat healthily – a number of nutrient deficiencies have been identified that can cause depression and low mood symptoms, so try to encourage your partner to eat a healthy diet with lots of fresh produce, nuts, seeds, legumes and olive oil and ensure they have enough fish each week (about 3 times a week and only the deep sea, ocean oily fish such as salmon, sardine, trout). Make sure you help your partner cook (or cook for them) to encourage the healthier diet. Use processed foods as little as possible and you should see an improvement in their symptoms (plus a more healthy family)
• Encourage your partner to socialise – if you have a partner who is depressed, they may feel very isolated, even if they are living with you and the rest of the family, so you need to gently, but insistently encourage them to socialise with other people; with you, the family and their friends. This will help your partner because they know that they have your support and it will help them feel less isolated and alone, which in turn can help to reduce their symptoms of depression
• Inform yourself about depression – try to get as much information about depression from your partner’s doctor (go with your partner to some of their appointments), from your partner and from qualified resources (both books and online) to help you understand what your partner is going through, so you can be as sensitive to them as much as you possibly can be
• Support – it is really important that your partner has your complete support and understanding. Depression is a very debilitating illness, irrespective of whether it is caused by nutritional deficiency or due to abnormal brain chemistry and your understanding is needed so that you do not make them feel worse for suffering from depression
• Talk to your partner – ask your partner if they would like to talk over any issues with you and try not to judge, as that will only make your partner less inclined to talk to you and feel more isolated from you. Just listen and let your partner talk out their issues. If you feel overwhelmed by this strategy, you can always encourage your partner (in a gentle and non-confronting way) to talk to a professional, which is now partly covered by Medicare, who may be in a better position to help your partner deal with their issues and depression

Friends

If you have a friend who has been diagnosed with depression, there are a number of strategies you can use to help them:

• Encourage your friend to socialise – it would be really beneficial for your friend if you gently, but insistently encourage them to socialise with you and their other friends. This helps your friend in two ways: (1) they know that you care and (2) they feel less isolated. Encouraging your friend to socialise with you may help them on their road to recovery
• Inform yourself about depression – especially if you are not familiar with depression yourself, it would be useful if you can inform yourself about depression from books and reputable online resources, so that you can try to understand at least a little of what your friend is going through with this illness
• Support – it is important that your friend has your support, that you are there if they need you and that you wont judge them harshly or tell them to “get over it”, because that is unhelpful. Just be there for your friend, to help them on their road to recovery from this illness

Parents

If you have a child who has been diagnosed with depression, there are a number of strategies you can use to help them:

• Encourage healthy eating – as there are a number of nutritional deficiencies associated with depression, it would be very beneficial for your child if you encourage healthier eating by preparing more fresh food and using fresh produce daily. Try to encourage your child to eat a healthy diet with lots of fresh produce, nuts, seeds, legumes and olive oil and ensure they have enough fish each week (about 3 times a week and only the deep sea, ocean oily fish such as salmon, sardine, trout)
• Inform yourself about depression – especially if you are not familiar with depression yourself, it would be useful if you can inform yourself about depression from books and reputable online resources, so that you can try to understand at least a little of what your child is going through with this illness
• Side effects to medication – if your child has to take any medication, make sure you reinforce the need for reporting any side effects they may experience, irrespective of how insignificant they may be
• Support – it is important that your child has your support, that you are there if they need you and that you wont judge them harshly or tell them to “get over it”, because that is unhelpful. Just be there for your child, to help them on their road to recovery from this illness
• Talk to your child – make time to talk to your child, but don’t try to force them to make conversation with you if they are not ready to do so, just let them know that you are available to talk in a non-judgmental, non-confrontational manner, so that it encourages your child to open up to you. Talking to your child will help improve your relationship and create a really nice bond between you

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Last reviewed and updated: 14 May 2024