Conditions > Depression

Welcome to the site of integrative nutritionist Blake Graham, director of Nutritional Healing in Perth, Western Australia. You may book an appointment for a consultation by phoning (08) 9487 7409 or emailing Nutritional Healing via the Contact page. You may also wish to join our FREE e-NEWSLETTER.


Definition

Depression is characterized by a feeling of intense sadness that is thought to be out of proportion to a stressful or sad event/situation, or may exist with no known causative event or circumstance. Depression becomes a disorder when the symptoms become severe enough to interfere with normal functioning for at least a few weeks ("major depression") or when relatively mild but chronic ("dysthymia"). Depression is an illness that affects mood, thoughts and behavior. Associated symptoms (association does not imply causation) of depression also often include fatigue, sleep disturbances, loss of interest or pleasure in most activities, changes in appetite and headaches.


Return to the top of the page

Issues

The Pfeiffer Treatment Center offers a unique and highly individualized nutritionally-based approach to treating depression. Between 90-150 differemnt laboratory tests are usually performed on each patient treated at the Pfeiffer Treatment Center. An outcome study of 200 depressive patients treated at the Pfeiffer Treatment Center found that 92% reported improvement and approximately two thirds found their anti-depressant medication where no longer necessary. They have developed an extensive database of biochemical information from the approximately 3200 depressive patients they have treated. An excellent article on their site, entitled Biochemical Treatment of Mental Illness and Behavior Disorders by William Walsh PhD, describes the five main biochemical subtypes of depression they developed from analyzing this database:

Table 1: Depression subtypes

High Histamine
(under-methylated)		 Low Histamine
(over-methylated)		 Pyroluria High Copper
(Hypercupremia)
Subtype patient
distribution*		 Greater than 50% ~20% ~20% 30% (45% of females & 3% of males)
Common
nutritional
imbalances		 Depressed calcium,
methionine, B6 and
excess folic acid		 Depressed folate, B3,
B12 and excess copper		 Depressed zinc, B6
and arachidonic acid
(an omega-6 fat)
Excess copper
and depressed
zinc
Common
neurotransmitter
imbalances		 High histamine and
low serotonin, dopamine and norepinephrine		 Low histamine and
elevated serotonin,
dopamine and
norepinephrine		 Low serotonin Very elevated
norepinephrine
Beneficial supplements Calcium, methionine,
magnesium, zinc, B6,
omega-3 oils, A, C, E
SAM-e, inositol & TMG		 B3, B12, folic acid,
manganese, zinc,
omega-3 oils, C, E
DMAE & choline		 B6, zinc & evening
primrose oil		 Zinc, manganese,
vitamin C & B6
Potentially
harmful supplements		 Folic acid, choline,
DMAE, copper
& histidine
Methionine, SAM-e,
inositol, tryptophan,
phenylalanine, St. John’s wort, tyrosine, copper, TMG & DMG		 Histidine, copper &
omega-3 fatty acids		 Copper containing
supplements
(including most
multivitamins)
& estrogen
Mood response
to SSRI* anti-depressants		 Positive Negative Positive Often Negative
Typical time taken to restore balance 3-6 months 2-4 months 1-2 months 2-3 months

* There may be some overlap between subtypes.
** SAM-e = s-adenosyl-methionine, DMAE = di-methyl-amino-ethanol, TMG = tri-methyl-glycine (betaine), DMG = di-methyl-glycine
*** SSRI = selective serotonin reuptake inhibitors

The following on site link is a tabulated catalog of typical chemical, physical and mental characteristics of these subtypes:

The following document, which contains information by William Walsh PhD from "Integrative Psychiatry" (a mailing-list for professionals), gives more details about these five depression subtypes:

The diversity and some of the specifics of treatment of each group is outlined in the above article. From their biochemical database of depressive patients, they have found that 95% fit into one or more of the groups above. Their database reveals that a significant proportion of people with depression do not have low levels of serotonin, which is often the basic principal for conventional and alternative biological treatments for depression. In fact, a subgroup of people with depression (approximately 20%) may have higher than normal levels of serotonin.

The Pfeiffer Treatment Center claims that due to the diverse chemical nature of the different biochemical subgroups for depression, some nutritional supplements for each group can exacerbate biochemical imbalances and be harmful for the individual. Biochemical characteristics must be determined with the help of a health professional before taking any of the supplements in the above potentially harmful row.

Related article:

Omega-3 fatty acids and depression

Omega-3 fatty acids are essential components of brain cell membranes, including those of neurotransmitter receptors. Omega-3 fatty acids also alter signal transduction and electrical activity in brain cells and control the synthesis of chemicals such as eicosanoids and cytokines, which may have a direct effect on mood. Lowered omega-3 fatty acid concentrations have been associated with mood disorders such as depression. Research indicates lowered concentrations in depressed patients, with some evidence indicating that severity of depression correlates negatively with omega-3 status; that is, the worse the depression, the lower the omega-3 level. Research also reveals the omega-3 fatty acid EPA (eicosapentaenoic acid) has the most potent antidepressant effects. A subgroup of people with depression, in the biochemical subgroup pyroluria, are often deficient in arachidonic acid, an omega-6 fatty acid, and generally benefit from evening primrose oil. Several clinical trials and reviews indicate a therapeutic effect of omega-3 supplementation for a large proportion of people with depression. Related on site link:

Table 2: Research on omega-3 fatty acid supplementation for depression

Supplement Subjects General Outcome Reference
EPA 20 Highly significant benefits Am J Psychiatry 2002 Mar;159(3):477-9
EPA Treatment-resistant & severely depressed Clinical improvement in all the symptoms of depression, reduced suicidal tendency and social phobia Int J Clin Pract 2001 Oct;55(8):560-3
EPA 70 patients with
persistant depression		 EPA was found to be effective in treating depression Arch Gen Psychiatry. 2002 Oct;59(10):913-9
EPA 30 women with borderline personality disorder Diminished aggression and severity of depressive symptoms Am J Psychiatry 2003 Jan;160(1):167-9
EPA+DHA 28 patients with major depressive disorder Significantly decreased depression score Eur Neuropsychopharmacol 2003 Aug;13(4):267-71
DHA 36 No significant difference between groups Am J Psychiatry. 2003 May;160(5):996-8

* DHA = Omega-3 fatty acid docosahexaenoic acid

The Omega-3 Connection: The Groundbreaking Anti-depression Diet and Brain Program
by Andrew Stoll MD (director of the Psychopharmacology research lab at Boston's McLean Hospital and assistant professor of Harvard Medical School Department of Psychiatry), 2001

In this book, Stoll outlines the evidence for omega-3 fatty acids in treating illnesses such as depression and bipolar disorder.

Related articles:

On psychiatrist Jerry Cott’s page are two graphical representations of fish or seafood consumption in relation to depression prevalence of different countries:

Amino acids, neurotransmitter synthesis and depression

The neurotransmitters serotonin and norepinephrine (noradrenaline) are of key importance to depression, both having mood regulating properties. Other neurotransmitters and neurochemicals implicated in depression include dopamine, PEA (phenyl-ethyl-amine), GABA (gamma-amino-butyric-acid), and histamine. Either too little or too much of these chemicals may contribute to depression.

Amino acids are the basic building blocks of proteins. The amino acids tryptophan, phenylalanine and tyrosine are precursors of the neurotransmitters serotonin, dopamine and norepinephrine, which have important mood regulating properties. These amino acids are contained in the diet and synthesized in the body. Supplementing these amino acids in people displaying evidence of neurotransmitter deficiency has been shown to reduce depressive symptoms in many people. The following are simplified chemical pathways by which these neurotransmitters are synthesized from amino acids:

Tryptophan --> 5-Hydroxytryptophan (5-HTP) --> Serotonin (5-Hydroxytryptamine)

Phenylalanine --> Tyrosine --> L-Dopa --> Dopamine --> Norepinephrine

Related articles:

These neurotransmitter synthesis pathways require the following nutrients to proceed:

Minerals, vitamins and depression:

Sensitivities and depression

Food and chemical sensitivities can contribute to depression in some people. In some people hidden food sensitivities could be a major contributing factor. Common sensitivities include:

Related articles:

Related book:

Hypoglycemia, carbohydrates and depression

Hypoglycemia is characterized by abnormally low blood sugar. Hypoglycemia can reduce the glucose supply to the brain, contributing to mood swings and depression. Consuming refined carbohydrates (white flour, refined sugar, etc.) often plays a role in the cause of hypoglycemia.

Related articles:

The essential amino acid tryptophan is the precursor of serotonin (Tryptophan --> --> Serotonin), which is delivered to the brain for synthesis of this important neurotransmitter. A number of studies reveal that brain uptake of tryptophan is proportional to blood tryptophan levels and inversely proportional to blood levels of other amino acids (large neutral amino acids [LNAA]), which compete with tryptophan for brain uptake. The tryptophan:LNAA ratio is an important determinant of serotonin biosynthesis. A similar situation applies to tyrosine, an amino acid precursor of dopamine and norepinephrine (Tyrosine --> --> Dopamine --> Norepinephrine). A number of studies have found that carbohydrate rich, low protein meals boost tryptophan:LNAA and tyrosine:LNAA ratios. (Am J Clin Nutr 2003 Jan;77(1):128-32 & Physiol Behav 1986;38(2):175-83)

Exercise and depression

Randomized controlled trials and reviews consistently report that exercise, particularly of an aerobic nature, has antidepressant effects:

Study Details Reference
One randomized controlled trial, with 156 subjects, compared the effect of an aerobic exercise program with that of antidepressants. The antidepressant group showed a more rapid initial therapeutic response but after 16 weeks the exercise was equally effective at reducing depression. Arch Intern Med 1999 Oct 25;159(19):2349-56
A recent randomized controlled trial found that exercise was
associated with a modest improvement in depressive symptoms
at 10 weeks.		 Br J Psychiatry 2002 May;180:411-5
A randomized controlled trial with major or minor depression
or dysthymia, tested the effect of a weight-training program
on sleep quality and depression. The exercise was found to
improve all subjective sleep quality and depression measures.		 Sleep 1997 Feb;20(2):95-101

Medical causes of depression.

A vast array of medical conditions can contribute to mental symptoms. All of these diagnostic possibilities should be considered. Pharmaceutical, psychological or even nutritional treatments will have limited benefit if the underlying cause of the problem is an undiagnosed physical condition, such as, brain tumors, temporal lobe epilepsy, sleep deprivation, carbon monoxide poisoning, lupus, typhus or head injuries.

Related articles:

What about emotional stress and psychotherapy?

While the focus of this page is on biochemical factors, emotional/psychological factors do play a role in most people with depression (a multifactorial condition). Emotional stress often acts as a “trigger” of depression, while underlying biochemical tendencies lead to the abnormal stress response, which is clinical depression.

“Most depressed persons were born with a biochemical predisposition for depression, which renders them particularly vulnerable to traumatic events and difficult life circumstances.”
- William Walsh PhD (co-founder and chief-scientist at the Pfeiffer Treatment Center)

The following quote from Patrick Holford’s new book 'Optimum Nutrition for the Mind', 2003, relates the importance of both biochemical and emotional support:

“Of course improving our mental health isn’t only about nutrition. While, sadly, most psychotherapists ignore the role of nutrition and the brains chemistry on how we think and feel, let’s not make the same mistake of omission.”

Emotional Freedom Techniques (EFT) for Depression

The Emotional Freedom Techniques (EFT) are based on the same principles as acupuncture, although involve tapping on selected points rather than using needles. EFT is sometimes referred to as "emotional acupuncture". EFT is an amazing technique which has been used to successfully remove/reduce negative feelings/emotions such as stress, depression, trauma, cravings/addictions, fears, phobias, anger/rage, pain, etc. which may be a major problem in themselves or may contribute to, or exacerbate, some other problem (e.g. Depression). Once learnt, EFT can be self-applied. There is a growing body of evidence that stress and other negative emotions contributes to a wide variety of health problems. Consistent with the alternative medicine belief that all illnesses are multifactorial, emotional issues (e.g. chronic stress) should be addressed in all people with chronic health problems. EFT complements nutritional/environmental therapies perfectly and is highly recommended by nutritional medicine figure Dr. Joseph Mercola. See www.integrative-clearing.com.au for an introduction to EFT and quality EFT consultations and workshops in Perth, Western Australia. Visit the official EFT website for more information and for a worldwide listing of EFT practitioners.


Return to the top of the page

Publications

Natural Healing for Schizophrenia & Other Common Mental Disorders by Eva Edelman, 1998

While this book was written predominantly in reference to schizophrenia, the principles described apply to mental illnesses generally. The book embraces the ideas concerning individuality and nutritional therapy currently used at the Pfeiffer Treatment Center. A quote from William Walsh PhD (co-founder and chief-scientist at the Pfeiffer Treatment Center) on the back cover states:

"This is the most useful volume on nutritional methods for mental illness written in the past 20 years. I believe that it will be a valuable resource for researchers, clinicians, and families alike. It is required reading for our research and medical staff."

The book also contains a detailed description of medical conditions known to contribute to mental illness. For anyone looking for alternative treatments for mental conditions, this book is a must read!

A Dose of Sanity: Mind, Medicine, and Misdiagnosis
by Sydney Walker, MD (psychiatrist and neurologist), 1997

This brilliant book discusses in detail why underlying medical conditions which contribute to mental symptoms must be carefully identified rather than simply treating the symptoms with medication, psychotherapy or even nutritional therapies. Case studies illustrate how brain tumors, hypothyroidism, heart conditions and sleep deprivation often produce symptoms mistaken for conditions such as depression, AD(H)D and schizophrenia. Every psychiatrist and psychologist should read this ground-breaking book! The following article discusses Sydney Walker's treatment protocol - Finding the Medical Causes of Severe Mental Symptoms: The Extraordinary Walker Exam

Nutritional Influences on Mental Illness: A Sourcebook of Clinical Research (second edition)
by Melvyn Werbach, MD, 1999

Melvyn Werbach, MD is a psychiatrist and nutritional medicine researcher. This excellent book contains a section on depression and reviews a huge amount of clinical research on it’s nutritional treatment. A considerably more detailed version of this document is available on the following CD-ROM:

Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry
by Carl Pfeiffer, MD, PhD, 1988

The Pfeiffer Treatment Center was named after Pfeiffer’s death in 1988.

The Mood Cure
by Julia Ross, MA, 2003

Julia Ross is a pioneer in the field of amino acid therapy for mood disorders. See her webpage The Mood Cure. The following article by Julia discusses 'The Role of Diet in Mental Health'.

Depression, Cured at Last
by Sherry Rogers, MD, 1997

Dealing with Depression Naturally
by Syd Baumel, 2000

(Many thanks to Syd for critiquing this page for me.)

Depression-Free Naturally
by Joan Larson PhD, 2001

(nutritionist and founder of Minnesota's Health Recovery Center)

Return to the top of the page

Recommendations

Return to the top of the page

Links


Key Terms


Return to the top of the page