What Is It?
The American Psychiatric Association has created a text called the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) in their attempt to define and classify depressive disorders. Many psychiatrists and addiction specialists who specialize in psychological disorders do not agree with all of the definitions or classifications in the DSM IV, however.
As stated in the DSM IV, depression is defined as persistent sadness, which lasts two or more weeks and interferes with daily life and normal functioning. Major depressive disorder is the technical term for this type of depression, which is diagnosed by the following specific criteria:
• Depressed mood (irritable mood in children and adolescents) most of the day, nearly every day, as indicated by either subjective account or observation by others
• Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
• Significant weight loss or weight gain when not dieting, or decrease or increase in appetite nearly every day (in children, consider failure to make expected weight gains)
• Insomnia or excessive sleep nearly every day
• Psychomotor agitation or retardation nearly every day
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness or excessive or inappropriate guilt nearly every day
• Diminished ability to think or concentrate, or indecisiveness, nearly every day
• Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, a suicide attempt, or a specific plan for committing suicide
The DSM IV lists two major types of depression–melancholic depression and atypical depression. Neurotransmitter testing may provide deeper insights for treatment protocols.
The deep limbic system – the brain’s emotional center – is saturated with GABA neurons, named for the potent calming brain chemical GABA that activates them. The brain chemicals serotonin and taurine are also considered calming because they enhance the ability of GABA to activate GABA brain receptors. Calming in the brain means decreased electrical stimulation—turning down the voltage. It is important for the GABA nerves in the emotional center to be activated in order to feel emotionally calm and peaceful. With serotonin and taurine deficiency and subsequent decreased GABA activity, the deep limbic system becomes over-electrified and, subsequently, a person commonly experiences symptoms of depression.
Serotonin also inhibits the activity of two stimulating brain chemicals, dopamine and histamine. Both dopamine and histamine activate the same dopamine receptors in the brain. They turn up the voltage in the brain overall. With substantial serotonin activity, the brain experiences over-stimulation. With knowledge of brain physiology, it is possible to understand yet another mechanism by which serotonin deficiency can result in an overactive deep limbic system and symptoms of depression.
There are indications in current research that the majority of patients with atypical depression suffer from an inherited brain disorder called reward deficiency syndrome (RDS). Since 1990, researchers led by Dr. Kenneth Blum have been gathering data to explain RDS. Today, it is known that their underactive pleasure center is derived from a particular gene. This gene produces a deficiency of dopamine D2 receptors, the so-called “happy receptors” in the brain’s pleasure center.
The reward circuitry in this region of the brain controls a person’s ability to experience pleasure and enjoy good things. When dopamine activates the specific “happy” receptor in the brain, pleasure is experienced. Patients with RDS experience less activity in their brain’s pleasure center than normal people, even when they produce normal levels of dopamine. Many of these patients are prescribed serotonin enhancing medications (SSRIs), which actually exacerbate their depression. Unknowing psychiatrists frequently misdiagnose these patients.
What Causes It?
Gut Imbalance/Candida Overgrowth
Since the widespread use of penicillin began about 65 years ago, antibiotics have been added to poultry and cattle feed. Antibiotics are ingested through poultry, milk, and, increasingly, in city water which is not filtered for antibiotics that enter the waterways. Antibiotic levels found in food and water have reached the critical threshold necessary to slowly destroy the normal flora or healthy bacteria inside the intestine.
Destruction of the healthy bacteria in the intestine allows excessive overgrowth of toxic Candida yeast and toxic bacteria. These pathogenic bugs create toxins that disable the brain’s pituitary gland shutting down production of healthy levels of the natural antidepressant hormones.
A common cause of atypical depression, which is rarely diagnosed by the average psychiatrist, is the accumulation of microbial toxins—most commonly Klebsiella bacterial toxins, Candida mycotoxins produced from Candida overgrowth, mold toxins derived from water damage inside the home, and toxins produced by the bacteria that causes Lyme disease. These toxins disable the brain’s pituitary gland shutting down the production of natural antidepressant hormones and disrupting normal transmission between brain cells.
When inflammation is present, tryptophan is depleted and quite often serotonin is not produced. This inflammatory immune response begins in the gut. The gastrointestinal tract is where much immune activation begins. The GI tract encounters far more foreign invaders on a daily basis than the internal (systemic) immune system encounters in an entire lifetime. This is a vital function of the GI tract and plays a role in the gut-brain connection which is maintained through both nervous system and immune system proper function. So the health of the gut is essential in regulating immune response and, thus, depression.
The gut inflammation that is produced by pathogenic bacteria creates increased intestinal permeability, or leaky gut, which allows toxins to pass through the gut wall and into the bloodstream triggering further inflammation that can travel anywhere in the body. In depression, the inflammation manifests in the brain.
Other acquired causes of serotonin deficiency derived from the gut include malabsorption and subsequent deficiency of vitamin D, vitamin B6, vitamin C and magnesium. Magnesium is a necessary cofactor for the chemical conversion of tryptophan to 5-HTP in the small intestine. Vitamins D, C, and B6 are necessary cofactors for the brain conversion of 5-HTP into serotonin. Any of these deficiencies can result in melancholic depression.
Brain toxicity derived from exposure to industrial solvents like toluene in paint thinners and volatile organic solvents such as benzene in gasoline, diesel fuel, and other industrial chemicals also disable brain serotonin factories, which leads to melancholic depression.
Prenatal exposure to the toxin bisphenol A (BPA) has been shown to increase depression-like behavior. BPA is found in the lining of food cans and in most hard plastics. It is a known hormone disruptor and should be avoided when possible.
As sexual hormones fluctuate throughout a woman’s life, imbalances may occur, fueled by underlying endocrine issues. The end result can be various forms of depression. Optimizing hormonal function, including thyroid, pituitary, adrenal as well as sex hormones may be critical to a positive outcome when striving to overcome depression.
Other non-biochemical causes of melancholic depression include a lack of parental nurturing during childhood, and repeated disappointments or continuous failures and negative experiences in adulthood. The deep limbic system stores the emotional component of memories. When the majority of memories are bad, the limbic system sets a more negative tone that may then reflected in personality.
Gluten sensitivity is another factor that should be considered with depression. Neurological disorders or findings have been found in up to 51 percent of patients with celiac disease, the most severe form of gluten sensitivity. Depression and anxiety were both found to be common features among those with celiac disease. Additionally, adherence to a gluten-free diet was found to improve depressive symptoms in celiac patients. This is yet another example of the gut-brain connection.
Vitamin D Deficiency
Seasonal affective disorder experienced by patients in northern latitudes during the winter months occurs when their exposure to sunshine is markedly decreased. Natural sunshine converts cholesterol in the skin to vitamin D, which enhances the conversion of tyrosine into dopamine, and, therefore, dopamine production is reduced when there is less sunshine-induced vitamin D production.
What Are the Signs and Symptoms?
Symptoms of melancholic depression are described in the psychiatric community as:
• Lost reactivity to events
• Dread about the future
• Decrease in appetite
• Weight loss
• Excessive guilt
• Worsening of depression in the morning
While it is difficult to work within the arbitrary constraints of the DSM IV manual, the symptoms as described for atypical depression are as follows:
• Excessive sleep
• Emotional response to events
• Social avoidance
• Sensitivity to rejection
• Increase in appetite
• Weight gain
• Worsening of depression at night
These symptoms are, for the most part, caused by an underactive reward or pleasure center. These individuals are unable to feel the so called “dopamine hit” in their pleasure center that most people experience when they hug a five-month old baby or a wriggly puppy. They often admit, behind closed doors, that when growing up, they just didn’t get as excited as their sisters or brothers when they got a new bicycle.
These patients may appear to be “just a quart low” on happiness and not outwardly depressed. They frequently lack motivation because motivation is somewhat dependent on dopamine activity in the reward center. They often appear lethargic and fatigued. They frequently have great difficulty getting out of bed in the morning. Their mothers will remember waking them three or four times in the morning, and that getting them to school on time was a struggle.
Brenda's Better Way
Depression is another one of those conditions that traditional doctors like to throw antidepressants at. In fact, you may be reading this information because a doctor told you that certain symptoms you have are “all in your head,” even if you know you aren’t depressed. You may actually have another condition that most traditional doctors do not know how to treat correctly. These include irritable bowel syndrome (IBS), fibromyalgia, chronic fatigue syndrome, Candida overgrowth, or multiple chemical sensitivity, each of which can trigger depression. Learning more about them may help you to uncover factors that are fueling your depression.
I truly believe that healing depression more times than not begins in the gut since so many digestive issues can trigger inflammation and nutrient deficiencies which can affect your mood. Building a healthy gut is the first step in building the foundation of your health. If symptoms persist it will then be helpful to find a doctor who is knowledgeable and open to balancing the brain chemistry by using neurotransmitter testing and hormone testing to get to the bottom of your condition. The following recommendations will help you on your journey.
• Comprehensive stool analysis (CSA)
• Food sensitivity test
• Neurotransmitter profile
• Hormone test
• Follow the Skinny Gut Diet Eating Plan.
• If Candida overgrowth is present, follow the Get Lean Phase of the Skinny Gut Diet Eating Plan.
• Include plenty of fruits and vegetables, whole grains, nuts, fish and poultry in the diet to help prevent anxiety.
• To avoid toxins in foods, eat organic foods whenever possible.
• Reduce consumption of saturated fat and eliminate trans fats from the diet.
• Regular physical activity can help to improve mood by releasing endorphins.
• If overweight, lose weight, especially if abdominal fat is present.
• Reduce toxin exposure.
• Get adequate sleep because lack of sleep can adversely affect mood.
Complementary Mind/Body Therapies
• Stress reduction therapies such as yoga, biofeedback, massage, and meditation can be helpful to relieve stress.
• Acupuncture may be helpful for people with depression.
• Colon hydrotherapy is beneficial to remove toxins.