While it may seem out of place to be talking about depression in the holiday season, mental health issues don’t take holidays. Depression is categorized into mild, moderate, severe. This article will focus on mild to moderate depression.
Depression is known as the great imposter. It can masquerade as feeling tired, lazy, overwhelmed. It can be at the root of physical pain, insomnia, weight gain. Depression is associated with a higher risk of coronary artery disease, metabolic syndrome and diabetes. It is important to be aware of depression and know where to turn when you need help. But this doesn’t always mean drug therapy.
How do you know if you’re depressed?
There are 2 screening questions for depression. Over the last 2 weeks, have you been bothered by either of the following problems:
1) Little interest or pleasure in doing things?
2) Feeling down, depressed or hopeless?
If the answer is ‘yes’ to either of these questions, you’ve been experiencing depression lately. Feeling down or depressed time to time is part of the human condition. However, when there’s more ‘bad’ days than good days, or depression is affecting relationships, livelihood, school or healthy habits, then it’s time to ask for help.
The first line therapies for mild to moderate depression are generally accepted to be non-pharmacologic and lifestyle-based. These are a few of them:
Talk therapy.
Counselling can be an invaluable part of depression treatment. I consider it essential for those transitioning off medication. At the very least, resist the urge to hibernate. Visit. Window-shop. Find reasons to be around others, if only for a small portion of the day.
Exercise.
Regular exercise is associated with improving symptoms of depression and lower relapse rates. The anti-depressant effect of exercise is in proportion to the intensity of the exercise, with some benefit noted even with ‘light’ exercise (ie walking)
Rule out hormonal imbalances that have an effect on mental health (thyroid, PMS, menopause, adrenal fatigue).
Address the hormonal imbalances to improve mental health. Some reports show that entering menopause doubles the risk of being diagnosed with a depressive disorder.
Clean up the diet.
A diet high in saturated fats and refined carbohydrates is considered detrimental to mental health as it creates inflammation in the brain and disrupts neurochemical signalling. Inflammation in the brain and body is also thought to decrease serotonin. Some of your best mood medicine can be food!
Targeted supplementation with nervous system nutrients. Adequate nutrition is needed for countless aspects of brain functioning. Unfortunately the most nutrient-deprived are often those at high risk for depression – adolescents and women after childbirth. Deficiencies of Folate, Iron, B12, B6, Magnesium, Essential fatty acids, Zinc, Selenium, Vitamin D can contribute to mild to moderate depression. The dose and forms of these nutrients are important. For example, studies have shown high dose fish oil (the EPA component specifically) to be more effective than Prozac in mild to moderate depression.
Omega 3’s are the main structural fats of the brain, but the EPA component specifically quells inflammation. Vitamin D3 deficiency is associated with Seasonal Affective Disorder, however the standard dose of 1000 IU/day is not enough to overcome a frank deficiency and dose needs to be adjudicated based on Vitamin D3 blood levels. Both B12 and Folic acid need to be in the activated, methylated form (5-MTHF). These are the forms that cross the blood-brain barrier and facilitate the production of dopamine, serotonin and norepinephrine. An estimated 20% of North American Caucasians, for example, are believed to have a genetic mutation (termed the MTHFR mutation) which prevents them from activating folic acid, which in turn puts them at a higher risk for depression.
Protect sleep.
While sleep deprivation or insomnia can be a symptom of depression, it can also be a perpetuating factor. Depression can also set up a cascade of poor sleep habits including mid-day napping and late night screen time. A sleep re-training process is often required to re-set the natural circadian rhythm of the brain, so sleep is more consistent and restorative.
Depression is a complicated medical condition to treat with each patient’s experience being unique and often requires a multi-disciplinary approach.