By Dr. Mercola
Depression is one of the most common mental health disorders in the U.S., where 15.7 million adults — or nearly 7 percent of the U.S. population — experienced at least one major depressive episode in the past year.1
Many of these individuals suffer in silence, sometimes feigning happiness to their family, friends and coworkers while inside feeling trapped in a dark place. In the video above, Doug Leddin shared his own story of living with depression for the past 10 years.
One of the biggest struggles for Leddin and likely for millions of others, is feeling like he's living a double life. He explained that friends would describe him as happy-go-lucky, and he feared letting out the secret that he'd been living with.
The worst part for him wasn't the debilitating sadness but the fear that he may lose his friends, loved ones and even his job because of it.
Why You Shouldn't Ignore Depression
About half of Americans diagnosed with depression don't receive treatment,2 which can be a dangerous decision. However, relying on antidepressants as a "cure" is misguided and potentially dangerous as well.
If you struggle with depression, getting help, including treatment that can help to address the underlying reasons for the condition, is essential. Left untreated, depression can not only take away your ability to enjoy life but also may lead to physical changes in your brain.
Specifically, recurring depressive episodes may reduce the size of your hippocampus — an area of your brain involved in forming emotions and memory — stressing the importance of early intervention, especially among teenagers.3
Your memory isn't only restricted to remembering dates and passwords; it also plays an important role in developing and maintaining your sense of self.
So when your hippocampus shrinks, it's not just your rote memory that's affected. Behaviors associated with your sense of self are also altered, and a smaller hippocampus equates to a general loss of emotional and behavioral functions.
The good news is the damage is likely reversible, but to do that you have to actually do something about your situation.
Depression May Not Be Due to an Imbalance in Your Brain
Contrary to popular belief, depression is not likely caused by unbalanced brain chemicals such as low serotonin that can be "corrected" with antidepressant drugs. The low-serotonin hypothesis, also known as the monoamine hypothesis, has been called into question numerous times.
According to a review published in Nature Reviews: Neuroscience, for instance, "… [R]ecent evidence indicates that problems in information processing within neural networks, rather than changes in chemical balance, might underlie depression."4 A study published in the New England Journal of Medicine further noted:5
" … [N]umerous studies of norepinephrine and serotonin metabolites in plasma, urine, and cerebrospinal fluid as well as postmortem studies of the brains of patients with depression, have yet to identify the purported deficiency reliably.
… No single mechanism can account for all the clinical variations in this condition. The monoamine oxidase theory can explain many of the actions of antidepressants, but genetic factors, stress, and psychosocial factors also play a part in depression."
If Low Serotonin Isn't the Problem, Then What Good Are Antidepressants?
The questions surrounding the low-serotonin hypothesis highlight one of the problems with treating depression using antidepressant drugs. SSRIs work by preventing the reuptake (movement back into the nerve endings) of the neurotransmitter serotonin.
This makes more serotonin available for use in your brain, which is said to improve your mood. But as explained by investigative health journalist Robert Whitaker, in 1983 the National Institutes of Mental Health (NIMH) investigated whether or not depressed individuals had low serotonin.
At that time, they concluded there was no evidence that there is anything wrong in the serotonergic system of depressed patients.
Research published in 2009 added further evidence to the pile indicating the low-serotonin idea was incorrect, as they found strong indications that depression actually begins further up in the chain of events in the brain.6 Essentially, the medications have been focusing on the effect, not the cause.
Drug companies kept running with the low-serotonin theory though, as it justifies the aggressive use of antidepressants to correct this alleged "imbalance."
Do Antidepressants Even Work for Most People?
Antidepressants are the most commonly prescribed class of medication other than antibiotics, taken by more than 1 in 10 Americans (and 1 in 4 among women aged 50 to 64).7
Many assume that such pills are the best available treatment for symptoms of depression, but in fact the difference between antidepressants and placebo pills is very small — and both are ineffective for most depressed patients.8
If you or your child is diagnosed with depression, be aware that there are many treatment options available, including cognitive behavioral therapy (CBT). In a systematic review of 11 studies, no statistically significant difference in effectiveness was found between second-generation antidepressants and CBT.9
Further, in a meta-analysis published in PLOS Medicine, only the most severely depressed showed any response to antidepressants at all and that response was quite minimal.10 This lack of effectiveness must be taken into consideration along with the drugs' side effects — of which there are many.
Serious Side Effects Associated With Antidepressants
Research suggests, for instance, that taking an SSRI may double your risk of bone fractures.11 This is because serotonin is also involved in the physiology of bone. If you alter serotonin levels with a drug, it can result in low bone density, boosting fracture risk.
A large study of post-menopausal women also found that those taking tricyclic antidepressants or SSRIs were 45 percent more likely to suffer a fatal stroke.12
Meanwhile, overall death rates were 32 percent higher in women on the drugs, while other research linked antidepressant use to thicker arteries, which could contribute to your risk of heart disease and stroke.13 Among the most concerning side effects, however — especially to society as a whole — are suicidal thoughts and violent behavior, which are well known side effects, particularly in youth.
In case you haven't heard, research conducted by Dr. Helen Mayberg, a professor of psychiatry at Emory University, may one day pave the way toward a more refined and customized treatment plan.
Mayberg identified a biomarker in the brain that can be used to predict whether a depressed patient is a good candidate for medication, or might be better off with psychotherapy. Perhaps one day that will help more people get the treatment that's truly right for them.
Natural Options for Treating Depression
If you are experiencing severe depression please seek help from a professional. For milder cases, and in addition to professional treatment for severe cases, the place to start is to return balance — to your body and your life.
If you're currently taking antidepressants and wish to stop, you should wean off them gradually under the care of a knowledgeable health care provider. Abrupt withdrawal from these drugs can lead to severe psychiatric or physical problems. You have nothing to lose, and everything to gain, by applying lifestyle modifications before trying medication, especially in children. You may be surprised by how much such changes lessen symptoms naturally.
Exercise
In addition to the creation of new neurons, including those that release the calming neurotransmitter GABA, exercise boosts levels of potent brain chemicals like serotonin, dopamine, and norepinephrine, which may help buffer some of the effects of stress. Many avid exercisers also feel a sense of euphoria after a workout, sometimes known as the "runner's high." It can be quite addictive, in a good way, once you experience just how good it feels to get your heart rate up and your body moving.
The Emotional Freedom Techniques (EFT)
EFT can be very effective by helping you to actually reprogram your body's reactions to the unavoidable stressors of everyday life. This includes both real and imagined stressors, which can be significant sources of anxiety. In the following video, EFT therapist Julie Schiffman discusses EFT for depression relief.
Please keep in mind that while anyone can learn to do EFT at home, self-treatment for serious issues like persistent anxiety or depression is dangerous and NOT recommended, and you should consult with an EFT professional to get the relief you need.
Optimize Your Gut Flora
Your gut and brain actually work in tandem, each influencing the other. This is why your intestinal health can have such a profound influence on your mental health and vice versa. It's also the reason why your diet is so closely linked to your mental health.
Prior research has shown that the probiotic Lactobacillus rhamnosus had a marked effect on GABA levels in certain brain regions and lowered the stress-induced hormone corticosterone, resulting in reduced anxiety- and depression-related behavior.14 The probiotic known as Bifidobacterium longum NCC3001 has also been shown to normalize anxiety-like behavior in mice with infectious colitis.15
So optimizing your gut flora with beneficial bacteria is a highly useful strategy. This is done by eliminating sugars and processed foods and eating plenty of non-starchy vegetables, avoiding processed vegetable oils, and using healthy fats. Additionally, eating plenty of fermented vegetables or taking a high-potency probiotic would be useful to reestablish a healthy gut flora.
Omega-3 Fats
Your diet should include a high-quality source of animal-based omega-3 fats, like krill oil. The omega-3 fats EPA and DHA play an important role in your emotional well-being, and research has shown a dramatic 20 percent reduction in anxiety among med students taking omega-3s.16
Dr. Andrew Stoll, a Harvard psychiatrist, was one of the early leaders in compiling the evidence supporting the use of animal based omega-3 fats for the treatment of depression. He wrote an excellent book that details his experience in this area called "The Omega-3 Connection."
Vitamin D
Optimize your vitamin D levels, ideally through regular sun exposure. Vitamin D is very important for your mood. In one study, people with the lowest levels of vitamin D were found to be 11 times more prone to depression than those who had normal levels.17
The best way to get vitamin D is through sun exposure or use of a high-quality tanning bed. A vitamin D3 supplement can be used if these aren't possible, but you'll need to monitor your levels regularly.
Lower Your Intake of Sugar and Processed Foods
In addition to being high in sugar and grains, processed foods also contain a variety of additives that can affect your brain function and mental state, such as monosodium glutamate (MSG) and artificial sweeteners. There's a great book on this subject, "The Sugar Blues," written by William Dufty more than 30 years ago, that delves into the topic of sugar and mental health in great detail.
Sleep
Get adequate amounts of sleep. You can have the best diet and exercise program possible, but if you aren't sleeping well you can easily become depressed. Sleep and depression are so intimately linked that a sleep disorder is actually part of the definition of the symptom complex that gives the label depression.
Anxiety drugs are also often prescribed for sleep troubles. I suggest first reading my Guide to a Good Night's Sleep for 33 simple tips on improving your sleep. Small adjustments to your daily routine and sleeping area can go a long way to ensure uninterrupted, restful sleep (which may further help with anxiety symptoms, as well).