Depression Introduction

:depression.jpg Depression is a clinical syndrome marked by alterations in the normal mood of an individual. This condition usually denotes a low, or sad mood. It also affects the physical and mental plains of the individual. There are several different forms of depression, and the classification for the varying forms of depression is dependant upon the severity of exhibited symptoms. For the purpose of this article, “depression” will refer to both the mild and moderate categories. The 3 most common types of depression are major depression, dysthymia, and bipolar disorder. [1]

Depression is thought to be caused by a chemical imbalance of certain neurotransmitters in the brain. The most commonly affected of these neurotransmitters is often serotonin, which is the chemical directly associated with feelings of happiness and positive mood. If an imbalance is present, persons are more susceptible to depression when a stressful life event occurs. There is also a belief that depressive states may be part of a familial component, as it tends to run in families. However, history shows that this condition does not always follow this trend. [2]

There are no specific time frames on the duration of mental anguish once an individual is diagnosed with depression. Episodes often occur only once in an individual’s life. However, many individuals do have a life-long struggles with depressive episodes.

Depression Symptoms

Individuals suffering from depression can present a myriad of symptoms, depending on the severity and type of depression. The typical symptoms that can occur with depression include, but are not limited to:

  • persistent sad feeling
  • feelings of hopelessness
  • guilty feelings
  • pessimism
  • loss of interest in hobbies or usual activities that were once enjoyed (including sex)
  • decreased energy
  • difficulty concentrating
  • hypersomnia
  • anorexia
  • suicidal thoughts
  • irritability
  • and persistent physical complaints that do not respond to normal treatment.[3]

Depression Statistics

  • It is estimated that 9.5% of the population, or 18.8 million individuals, will suffer from a depressive episode in any given year. [4]
  • Only 20% of these individuals, or 3.6 million, will seek treatment, even though 80% of all depressive episodes are treatable.
  • 16% of all adults will experience a depressive episode at some point in their life.
  • 97% of individuals with depression will report that it has a negative affect on their home and work environments, as well as their relationships. [5]
  • The mean age of women affected by depression is 25-44.

Depression in Women:

  • Women are two times as likely to be depressed than men.
  • 7 million women in the US are said to be clinically depressed in a given year.
  • 1 in 5 women will develop depression at some point in their life.
  • 15% of women who suffer from depressive episodes will commit suicide.
  • 10% of women will experience postpartum depression. [6]

Depression in Men:

  • 3-4 million men are affected by depression. [7]
  • Men are 4 times as likely to commit suicide than women, though they are affected less.
  • Men are more likely to have a depressive episode after becoming unemployed.
  • The majority of men who are depressed are single, widowed, or divorced. [8]

Depression in Children and the Elderly:

  • The prevalence of depression in children is on the rise. 2.5% of children and 8.3% of adolescents suffer from depressive episodes.
  • An estimated 6 million elderly are believed to suffer from depression.
  • 25% of all suicides from depression are in the elderly population.
  • 15% of people over the age of 65 suffer from depressive episodes, and only 10% of those seek help. [9]

Depression Treatment

Treatment for depression in conventional medicine is determined by the severity and type of depression. Most cases of depression will be treated on an outpatient basis. For mild depression, psychotherapy is the preferred method of treatment. This therapy can be with completed with visitations to a counselor, psychologist, or psychiatrist. For moderate to severe depression, psychotherapy is used in conjunction with specific medications.

SSRI’s, or selective serotonin re-uptake inhibitors, MAOI’s (monoamine oxidase inhibitors), and HCA’s (heterocyclic antidepressants) are the most common medicines used in patients with moderate to severe depression. Other medication that may be prescribed include 5-HT antagonists and catecholaminergics. [10] Because of the activity these drugs have on specific neurotransmitters in the brain, one is advised not quit the drug at once; as this may lead to a more serious rebound depression. Any changes in a treatment protocol should be under the supervision of a licensed physician.

There are some alternative treatments that have been effective treating mild to moderate depression. Due to the pronounced effects of these treatments on the levels of neurotransmitters in the brain, it is recommended that individuals consult a physician before beginning any alternative treatment program. Many of the common drugs used to treat depression interact with alternative treatments, and may eventually cause ‘serotonin syndrome’. Serotonin syndrome results from an excess of serotonin in the brain, and can cause high blood pressure, increased heart rate, anxiety, etc.

Supplements helpful for Depression Treatment

St. John’s Wort (Hypericum perforatum) St. John's Wort has been extensively studied as a treatment for depression. It is useful alone for mild to moderate depression, and can be a valuable addition to drug therapy for severe depression. The exact mechanism of its action is still not completely understood. St. John’s Wort appears to increase the levels of neurotransmitters in the brain, including serotonin, norepinephrine, and dopamine. [11]

One study compared the effects of Hypericum extract to imipramine, an HCA. It was found that Hypericum yielded therapeutically equivalent results, and far fewer side effects than imipramine. Patients also tolerated St. John’s Wort better than HCA. [12] Another study, comparing /Hypericum extract to the SSRI, sertraline, indicated that St. John’s Wort was as effective for mild to moderate depression as sertraline. [13] In another study, comparing Hypericum// to placebo in mild to moderate depression, patients had significant benefit. A significant number of patients had a greater than 50% improvement in just 6 weeks. [14]

Tryptophan Tryptophan is the amino acid precursor to serotonin, a neurotransmitter in the brain. Supplementation with tryptophan can increase the production of serotonin. Tryptophan is often depleted in patients with depression. In various studies, tryptophan has been effective in treating mild to moderate depression. In one particular study, tryptophan was found to increase the benefit of Fluoxetine, a SSRI, without causing serotonin syndrome. [15]

Folic Acid Folic acid is a vitamin necessary for proper functioning of the central nervous system. The level of folic acid in the serum or blood of patients with depression has proven to affect treatment. One study found that low folic acid levels were associated with a decreased treatment response to SSRI’s and HCA’s in patients with major depression. Folic Acid supplementation increased the effectiveness of these commonly prescribed drugs. [16] Another study found that deficient levels of folic acid were related to the degree of depressive disorder. [17]

DHEA DHEA is a steroid hormone precursor produced by the body. It has been studied as a treatment for major depression. Fluctuating hormone levels are thought to contribute to depressive episodes. The exact mechanism for DHEA and it influence upon depression is not fully understood, though is has some effect on neural cell receptors in animal models. Supplementation of DHEA for 6 weeks resulted in significant antidepressant effects and a decreased score on the Hamilton depression scale in patients with major depression. [18]


[1] National Institute of Mental Health. November 2004.

[2] National Institute of Mental Health. November 2004.

[3] National Institute of Mental Health. November 2004.

[4] National Institute of Mental Health. November 2004.

[5] November 2004.

[6] November 2004.

[7] National Institute of Mental Health. November 2004.

[8] November 2004.

[9] November 2004.

[10] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. Pages: 1531-1538.

[11] St. John’s Wort. November 2004.

[12] Woelk H. Comparison of St. John’s Wort and imipramine for treatment of depression: a randomized controlled trial. BMJ. 2000 Sep 2; 321(7260): 536-539.

[13] Brenner R, Azbel V, Madhusuodanan S, Pawlowska M. Comparison of an extract of Hypericum perforatum (LI 160) and

sertraline in treatment of depression: a double blind randomized pilot study. Clin Ther. 2000 Apr; 22(4): 411-419.

[14] Lecrubier Y, Clerc G, Didi R, Kiser M. Efficacy of St. John’s Wort extract (WS 5570) in major depression. Am J Psychiatry. 2002 Aug; 159(8): 1361-1366.

[15] Levitan RD et al. Preliminary randomized double blind placebo controlled trial of tryptophan combined with fluoxetine to treat major depressive disorder: antidepressant and hypnotic effects. J Psychiatry Neurosci. 2000 Sep; 25(4): 337-346.

[16] Papakostas GI et al. Serum folate, vitamin B12, and homocysteine in major depressive disorders: Part 1: predictors of clinical response in fluoxetine resistant depression. J Clin Psychiatry 2004 Aug; 65(8): 1090-1095.

[17] Tiemeier H et al. Vitamin B12, folate, and homocysteine in depression: the Rotterdam study. Am J Psychiatry. 2002 Dec; 159(12): 2099-2101.

[18] Wolkowitz OM et al. Double blind treatment of major depression with dehydroepiandrosterone. Am J Psychiatry. 1999 Apr; 156(4): 646-649.


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