Monday, December 10, 2012

Beat the Winter Blues

The days are shorter. The landscape is dull and barren. The weather is, at times, harsh and unwelcoming. It's no wonder many people feel glum during winter. Add to that the stress of the holidays, and you have a recipe for full-blown depression. But whether you develop a mood disorder out of the blue, or you experience depressive symptoms every winter (a condition known as seasonal affective disorder, or "SAD"), there are treatments and preventive measures that will help you get back to your normal self.

"D" is for Daylight
Most people do not get enough exposure to sunlight during winter. They go to work when it's dark, and by the time they get home, the sun has already gone down. This reduced exposure to sunlight means most people aren't making enough vitamin D.

Vitamin D is important for a number of functions in the human body in addition to building bone. It boosts the immune system and helps to fight cancer. Without it, we slow down, get sluggish and gain weight. This is due to the connection between Vitamin D and thyroid. Sufficient levels of Vitamin D are necessary for optimal thyroid function. If we were bears and hibernated throughout the winter, less would be fine. (We would get hypothyroid) But because we are humans on the go, we need the extra support that vitamin D can give.

Another important benefit of this vitamin is that it can positively affect the brain. In recent years, doctors have noticed that patients who experience depression or SAD tend to be low on vitamin D. Research confirms this connection as well. A study of people in nursing homes found that taking vitamin D improved their depression and cognitive abilities.

Actually, older adults should consider taking vitamin D year-round, with an increased dose in winter. Older adults do not make as much Vitamin D in the summer as their children and grand children.

A Secret Weapon for Serotonin Production
Here's a challenge: Look up the amino acid 5-hydroxy tryptophan (5-HTP) on the internet. You're likely to find lots of warnings against using it in conjunction with SSRIs, (selective serotonin reuptake inhibitors), the most commonly prescribed class of antidepressants. The truth is, 5-HTP can be a great addition to depression treatment, especially considering the tendency for SSRIs to become less effective over time.

5-HTP crosses the blood brain barrier and is converted to serotonin, 5-hydroxytryptomine (5-HT), which is a calming neurotransmitter that promotes self esteem, reduces the tendency to feel overwhelmed, reduces fear, reduces the tendency to be overly critical of others and of oneself and decreases the tendency to worry. People with adequate serotonin are happier with themselves and their surroundings.

Deficiencies or disruptions in serotonin can lead to depression or obsessive compulsive tendencies. SSRIs play only one role in correcting this problem, however. They allow serotonin to remain in brain synapses longer so that downstream nerves get a higher concentration of the neurotransmitter. While this is helpful, it does not address the problem of deficiencies in serotonin.

SSRIs only rearrange where serotonin is; they don't stimulate production of more of it. And, in fact, these antidepressants can lead to a reduction in serotonin levels over months to years. In the late 1980s when Prozac, the first SSRI, became popular, doctors began noticing a phenomenon known as "Prozac poop-out." Patients would respond successfully to the drug at first, but then their symptoms would start returning.

It's now believed that SSRIs' continual blocking or inhibition of the serotonin reuptake devices in the brain may actually reduce the amount of serotonin being produced. This finding surprised a lot of doctors. To get around the problem, they began changing dosages and prescribing additional anti-depressants, beta-blockers or naltrexone. But none of these changes really helped patients achieve the results they had when first taking SSRIs.

Integrative physicians, however, quickly realized that 5-HTP would assist SSRIs by helping increase the amount of serotonin in the brain. Traditional doctors still stay away from this practice because they fear it will create a condition known as serotonin syndrome. This syndrome, which is marked by hypertension, profuse sweating, diarrhea and possible psychosis, can occur if too much 5-HTP is taken. However, in small doses, it can safely produce positive results for depressed patients.

Many integrative physicians prescribe 5-HTP to patients regularly, and in the 20-some years since SSRIs have been out, most have never had a patient experience a life-threatening reaction to the combination of an SSRI and low doses of 5-HTP.

Incorporating 5-HTP into Depression Treatment
There are a number of ways to find out whether or not your serotonin is low. One way is if you notice your SSRI isn't working as well as it used to. Another is to take inventory of your mood and actions. If you're low on serotonin, you'll notice some of the following things:

  • A hypercritical attitude—particularly as it relates to your feelings about yourself
  • Feeling overwhelmed
  • A need for control
  • Indecisiveness
  • Obsessive compulsive feelings (this occurs with very low serotonin)
  • Craving carbohydrates like bread, rice and sugar

 The way to determine whether or not a patient might benefit from 5-HTP in conjunction with his or her antidepressant is by taking a thorough history. Questionnaires are also helpful. Usually this is enough data to determine the need for 5-HTP. Then one can take a small dose of 5-HTP and increase it slowly.

Sometimes, a urine test is useful. Serotonin is made in the brain, but it is excreted in the urine. So by monitoring a patient's urine levels, a doctor can determine a patient's serotonin level.

If a depressed patient's urine has low levels of serotonin, that's an indication that his or her brain doesn't have the serotonin levels necessary for an SSRI to properly rearrange the concentrations of the neurotransmitter. Then one can use 5-HTP to increase the patient's serotonin levels. This will help the SSRI work better, and it may reduce the patient's dose of the SSRI. This, in turn, tends to reduce any side effects the patient experiences from taking the antidepressant.

Always start patients out on the lowest dose of 5-HTP possible— 50-100mg a day. Over time, increase the dosage. Most people require between 200mg and 500mg a day. The maximum dosage recommended  is 800mg daily, divided up into 200mg four times a day. If a patient is on an SSRI, they will usually use 100-400mg daily. If a person seems particularly sensitive to 5-HTP and is experiencing an increase in side effects similar to those felt with the SSRI, reduce the dosage..

The nice thing about 5-HTP is that it's easy to monitor. People respond to it within 30 minutes. A single dose lasts 4-6 hours. This not only means they start feeling better sooner; it means one can make dosage adjustments quickly.

Another advantage of 5-HTP is that it only needs to be taken as necessary—and can even be taken alone (without an SSRI). Some people may only need it in wintertime; others may just require it to get them through a rough period.
The brain needs magnesium and activated vitamin B6, Pyridoxyl-5-phosphate, P-5-P to make serotonin from 5-HTP. So take these or take a good multiple vitamin that contains them.

Tryptophan also works. It is converted in the brain into 5-HTP. It is in turkey and other foods or can be bought as a supplement. Doses are 5-10 times higher than 5-HTP since only 10-20% of it is converted to 5-HTP. Cofactors for this conversion are oxygen, iron and the cofactor, tetrahydrobiopterin (BH4).

No one has ever developed Eosinophilic Myalgia Syndrome when taking real tryptophan. Those that had a severe reaction in 1987 to a batch of imported tryptophan from Japan were actually consuming a genetically modified tryptophan.  It wasn’t “contaminated”. It was a genetically engineered tryptophan.

Consult with your physician or psychiatrist before using 5-HTP or tryptophan.

A Helpful Herb
Another commonly prescribed treatment for SAD and depression is St. John's Wort, which is often known as the antidepressant of the herb world. St. John's Wort raises the number of many neurotransmitters in the brain, not just serotonin. While the herb works well in the treatment of depression, it does take a little longer to produce results than 5-HTP. So, if you're using it to treat SAD, you may want to start taking it in late summer every year before your depression symptoms kick in. If your mood is easy to track by seasons, this can be a great preventive treatment for you.

If you choose to take St. John's Wort, just be cautioned that it can interact negatively with some prescription medications, like HIV drugs. And unlike 5-HTP, St. John's Wort shouldn't be taken with SSRIs. To be on the safe side, consult with your physician before taking this, or any, herb.

Nothing Happens without Fish Oil
You can take all the above drugs, vitamins and supplements and still be “blue” if you have sick, starved cells. If one does not have enough fish oil (DHA in the brain and EPA in the body), the cells are malnourished, toxic, energy poor, and isolated. All cells, including nerve cells, have receptors on their cell membranes. These receptors are the communication sensors for the cell.

Serotonin may be knocking at the door of the down stream nerve across the synapse, trying to tell it “Don’t worry, be happy”, but it will fall on deaf ears if the nerve doesn’t have healthy receptors. Low levels of DHA and high levels of saturated and trans fats make the nerve cell membrane stiff. When serotonin floats into a receptor on the down stream nerve, the receptor changes shape to signal to the cell that serotonin has arrived. It can’t move in a stiff membrane so the message never arrives. The receptors need to be able to wiggle. They can only wiggle in a flexible membrane.

Secondly, depression is an inflammatory disease. DHA and EPA are fundamentally anti-inflammatory molecules. If you are depressed take at least 2400mg of EPA+DHA. You may need even higher doses.

A Menu of Treatments for SAD and Depression
Vitamin D, SSRIs, 5-HTP, tryptophan, St. John's Wort and fish oil are not the only treatments for depression. There are a number of treatments, both medical and behavioral, that can help:
  • Neurofeedback. This treatment can provide electromagnetic feedback to the brain, which helps the practitioner re-train the brain. In my 30 years of medical practice, I've seen many people helped by this therapy.
  • Energy Therapy. Acupuncture, Reiki, Healing Touch, Emotional Freedom Technique and other forms of energy therapy have been demonstrated to help improve symptoms of depression.
  •  Counseling. This method doesn't cure depression by itself, but it can help you cope with and adjust areas of your life that are in need of repair.
  •   Faith. A belief that in some spiritual or cosmic sense that one's life matters is hugely important in helping a depressed person think past the low points.
  • Laughter. Humor heals. A sense of humor and laughter are some of your strongest weapons against depression.
  •  Exercise. There have been countless studies showing the connection between physical activity and mood improvement. In fact, exercise is now a universally recommended treatment for depression. This is because it optimizes the amount and balance of every neurotransmitter in our bodies.
  •  Dietary Changes. Avoid foods that drain your body of energy; eat foods that nourish it. Indulge now and then, but remember: your brain needs real food to thrive. The more processed the food, the less it will nourish your body and brain.
  •  Detoxification. Eliminating toxins from your body helps "free up" neurochemicals. Some people's brains hold on to heavy metals like mercury, which can interfere with neurotransmitters.

Get a Checkup
First see your doctor or other health care provider. Depression isn't always due strictly to neurochemical factors. Many people suffer from the mood disorder because they don't have enough of certain vitamins and minerals. B vitamins—especially thiamin, folic acid and B6—are essential to good mental health. You also need proper levels of magnesium and iron to support the production of neurotransmitters like serotonin.

Normal thyroid function, Vitamin D and A, and minerals are all important.

For a person suffering from depression, get full blood work, including a complete iron panel, Vitamin D and A levels, B-12 and folic acid levels, and thyroid levels.  This is in addition to a urine test that determines serotonin levels in the body.

Take care of yourself this winter. And thrive in 2013!

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