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What do you mean depression isn’t just in my head?

The latest research tells us that depression is not just how we think and feel, but a complex set of physiological reactions linked through inflammation.

By Neil Bridgeman
Aug 23, 2021 • 9 min read

Traditional biology tells us that depression, or major depressive disorder (MDD as it’s otherwise referred to clinically) is a depletion of neurotransmitters, specifically serotonin (the one that makes us happy), dopamine (the one that’s associated with reward) and norepinephrine (the one that gives us our get up and go).

It’s a solid theory and still holds true. But behind what is known as the monoamine theory (the depletion mechanism I just mentioned), is actually a complex set of biochemical domino-like processes that kick into effect off the back of an acute trigger, stressor or traumatic life-event. This typically sparks a response in the primitive part of our brain known as the amygdala, setting off a chain reaction of neural, hormonal and immunological responses aimed to induce sickness behaviours that allow us to stop, rest, revive and repair ourselves.

Makes sense, right? Traumatic life event – slow down, rest, take time to recuperate. Now, in today’s rat-race paced life, we rarely allow ourselves the opportunity to do this. We (try) often to push through and this is where things get understandably tough for a lot of people.

“There is no quick fix with depression. In truth, it needs to be approached from a number of angles”

Depression and anxiety are closely interlinked. It is rare to be suffering with depression and not also be suffering with anxiety, the same holds true the other way around. The tricky thing with both is that we only take stock often when it reaches acute stages. So how does depression present itself?

Patients with depression typically present with:

–    dysphoric mood

–    inability to feel pleasure in normally pleasurable activities

–    altered physical states such as weight loss or gain

–    increased or decreased appetite

–    chronic fatigue

–    disordered sleep patterns

–    lack of libido

–    changes to menstrual cycle

–    slow speech

–    social distancing

–    suicidal thoughts can also manifest 

There is no quick fix with depression. In truth, it needs to be approached from a number of angles – a combination of cognitive behaviour or talking therapies, nutrition and lifestyle interventions, appropriate medication and/or supplementation as well as supportive social networks. Depression isn’t a get-well quick disorder; it takes time and multiple modalities to treat it successfully.

This is where what we eat and lifestyle can make a big difference in supporting those suffering with depression. 

With close to 50% of patients considered treatment-resistant after two rounds of antidepressants, a holistic body-mind approach is helpful for effective, long-term management.

As a nutritionist, I look at depression from a 5-stage perspective:

1/ Short-term symptom relief

2/ Normalising the underlying stress response

3/ Reducing chronic inflammation

4/ Improving nutritional status

5/ Long-term lifestyle changes

First, I focus on immediate symptom relief layered with longer term tactics aimed at reducing inflammation, improving insulin sensitivity, balancing neurotransmitter production, and normalising the body’s chronic stress response.

In parallel, cognitive behaviour therapy is encouraged. It is a powerful primary tool to treat depression – in fact, CBT patients experience almost half the rate of relapse at 24 months than those who stop taking antidepressants.

In these first few stages, I lean on a variety of botanicals and supplements to support symptom relief including St John’s Wort, saffron, ashwagandha and magnesium.

But it’s not just a matter of taking a few supplements and herbs, lifestyle modifications are key in long-term management of depression. Aside from quitting smoking, reducing alcohol intake and cutting back on caffeine, diet and exercise are the most effective interventions.

A Mediterranean style diet offers an abundance of micronutrients, omega-3 fatty acids, fibre, prebiotic sources and polyphenols which play important antioxidant and anti-inflammatory roles – all have beneficial effects on down-regulating the inflammation associated with depression. Additionally, polyphenols (found in extra-virgin olive oil) have been found to increase the expression of brain-derived neurotrophic factor (BDNF) and support the growth of new synaptic connections in the brain. Depression physically alters the areas of our brain responsible for executive function, emotion, memory and learning – all the more necessary to support neurogenesis.

Exercise and movement also play a key role in the management of depression symptoms. Yoga is well-established to down regulate the body’s stress response and calm the nervous system. While exposure to nature is also associated with a lower prevalence of depression – with the optimal dose of 5-7 hours over the space of 4-5 times per week.

These, as well as other practices like resonant breathing, are just some of the tactics I work with to wrap around primary depression treatment.

If you feel things are off, fill out the PHQ-9 questionnaire – an internationally standardised set of questions that give you a score on mild, moderate or acute depression and/or anxiety – you can find it on the NHS website. And of course, if you are struggling or at crisis point, CALM and Samaritans offer invaluable helplines – call them if you need to.

References

Anthes, E. (2014) ‘Depression: a change of mind’ Nature, 515 (7526), pp. 185‐187

Berk, M. Williams, L. Jacka, F. et al. (2013) ‘So depression is an inflammatory disease, but where does the inflammation come from?’ BioMed Central Medicine, 11, pp. 200

Capuron, L. Lasselin, J. & Castanon, N. (2017) ‘Role of Adiposity-Driven Inflammation in Depressive Morbidity’ Neuropsychopharmacology, 42 (1), pp. 115–12

Cox, D. Shanahan, D. Hudson, H. et al. (2017) ‘Doses of Nearby Nature Simultaneously Associated with Multiple Health Benefits’ International Journal of Environmental Research and Public Health, 14 (2), pp. 172

Dean, J. & Keshavan, M. (2017) ‘The neurobiology of depression: An integrated view’ Asian Journal of Psychiatry, 27, pp. 101-111

DeRubeis, R. Siegle, G. & Hollon, S. (2008) ‘Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms’ Nature Reviews. Neuroscience, 9 (10), pp. 788–796

NHS (2019). Symptoms Clinical Depression [Online]. Available at: www.nhs.uk/conditions/clinical-depression/symptoms

Prathikanti, S. Rivera, R. Cochran, A. et al. (2017) ‘Treating major depression with yoga: A prospective, randomized, controlled pilot trial. PloS One, 12 (3)

Raison, C. & Miller, A. (2017) ‘Pathogen-Host Defense in the Evolution of Depression: Insights into Epidemiology, Genetics, Bioregional Differences and Female Preponderance’ Neuropsychopharmacology, 42(1), pp. 5-27

Ravindran, A. Balneaves, L. Faulkner, G. et al (2016) ‘Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 5. Complementary and Alternative Medicine Treatments’ Canadian Journal of Psychiatry, 61 (9), pp. 576–587

DISCLAIMER: The information provided on this website is for informational purposes only and should not be used for diagnosis. It is not intended as a substitute for advice from your GP or other qualified health practitioner.

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