The Depression Trap

A recent study has indicated a link between depression with high levels of somatisation (i.e. physical symptoms such as fatigue, appetite changes etc.) and the ability of our cells to produce energy efficiently. Mitochondria in our cells take in nutrients and produce energy in the form of ATP for the cells to use. In some people the mitochondria works inefficiently and so not enough energy is produced. The suggestion is that some people may have a genetic pre-disposition towards depression (particularly the type of depression that has a lot of physical symptoms) due to low energy production in their cells.

This could be good news in terms of screening and treatment. If patients with somatic depression can be tested easily and cheaply for the relevant mitochondrial problems then a treatment which addresses the energy production can be tried. In fact there are already a number of nutritional supplements available without prescription that are thought to help with cell energy levels.

Coenzyme Q10
Thought to be vital for the process of ATP recycling in the mitochondria of the cells. It has been widely used in conditions where fatigue and insufficient energy production is a factor including Chronic Fatigue Syndrome. It is also an antioxidant helping to protect the body from free radicals which may cause cell damage.

D-ribose
ATP is usually created in the body from a related chemical called ADP. When this process does not work efficiently the body can make ATP from a form of sugar called D-ribose. D-ribose has also been used successfully treat chronic fatigue syndrome. Supplements of D-ribose allow the body to increase its levels of ATP and hence increase the energy available to cells.

L-Carnitine
This is an amino acid that is required to carry fats into the mitochondria where they can be used to produce ATP.

NADH
Another intermediate energy carrier in the mitochondria which has a similar job to coenzyme Q10. Available as a supplement and has been used to treat CFS.

Vitamin B2 (Riboflavin) and Vitamin B3 (Niacin)
Niacin is used to make NADH in the body. This is an intermediate energy carrier in the mitochondria, it performs a similar function to coenzyme Q10. Riboflavin is used in the same way to produce FADH, which has the same role as NADH in energy production.

There is already anecdotal evidence that these supplements have helped some people to overcome depression, however more research is needed to confirm their effectiveness.

The latest study shows interesting results, but do we know whether these individuals were born with low functioning mitochondria, or whether it developed later. Can we be sure that this is a purely genetic condition, or something that may have developed later? If it develops later what causes it? If it’s genetic what are the factors that cause some people with this genetic condition to develop depression whilst others don’t. As usual there are as many questions as answers, but if you are suffering from somatic depression then it might well be worth trying the supplement approach.

The full text of the report is available for a fee from Psychotherapy and Psychosomatics

This year Depression Awareness Week will be 21 to 26 April. This is an annual campaign to raise awareness about depression organised by the Depression Alliance. You can find out more about the campaign and how to get involved on their website.

During the week I will be offering a free copy of my Ebook to visitors to this website. Just return to this website during that week for information about how to claim your copy. I will also be raising money for the Depression Alliance by doubling my usual donation for each book sold during that week.

This morning I woke up and the sun was shining. I immediately felt more positive than I had yesterday, a dull, overcast day. This reminded me that a number of my clients have also commented on how they feel better on a sunny day. You may be familiar with Seasonal Affective Disorder (SAD), a type of depression triggered by the lack of sunlight in the winter months, but it may be that exposure to sunlight also has an impact on those suffering from more traditional forms of depression.

No one is sure why sunlight should have an impact on our mood. Some theorise that it has an impact on our levels of serotonin and other mood related hormones. This may be because our body clock gets out of balance during the short winter days and therefore too much melatonin is produced. It may also be that we have positive associations to sunlight e.g. summer holidays, long lazy days in childhood etc. This could be why just waking up and seeing a blue sky with the sun shining can help us to feel in a more positive mood.

Whatever the reason, it’s worth taking note of whether or not your depression is effected by sunshine. With spring upon us this is s a good time to take note of your reaction to the sun. You could keep a sun-mood diary, writing down each day how you feel on a scale of 1 to 10 and making a note of whether it’s cloudy, sunny, etc. If you find you are effected by sunlight then its worth taking some steps to increase your exposure. Consider the following:

1. Spend 20minutes outside each day. This can be especially important in the winter when there is less sunshine. An excellent approach is to take a 20 minute walk, as this also ensures that you get some exercise. Why not experiment with what works for you? Try a 20 minute walk each day for a few weeks and see how you feel.
2. Gardening is an excellent way of spending time in natural light all year round and is good exercise too.
3. In the summer you may choose to sit outside and read, chat to friends, or just lie down and relax. (Though do be careful to use sun tan lotion if you are going to be outside for any length of time.)
4. Actively think about how you can spend more time outside. If its warm enough to sit outside then all kinds of tasks can be taken outside – sewing, reading a magazine, writing letters, even peeling vegetables.
5. If you find you are really affected by sunlight then you may want to invest in a full spectrum lamp (SAD lamp). These lamps mimic the effect of sunlight and by spending time under one in the winter months you can help to lift your mood. There have been a number of studies showing that such lamps can be very effective in treating SAD and there is some evidence that they may help with other forms of depression too.

A Recent study by Researchers from the University of Illinois highlights some of the problems with trying to study depression using the biological model. In this study they compared the brains of depressed people who had committed suicide to those of non depressed people who had committed suicide. They found differences and suggest that these differences could be used to diagnose depression and measure the effectiveness of anti-depressants.

Studying the biological basis for depression is always going to be difficult as we can’t just cut up the brains of sufferers to see what’s happening. There are certain tests that can be done with a live patient, but they are limited.

However, reading about this study left me with a number of concerns.

Firstly, most depressed people do not actually commit suicide, so can we take this small sample as representative of all those with depression? Clearly not and to be fair the team do intend to do further research. Secondly, how do we know for certain that the control group were not depressed? Had they been tested in some way? Or is it just that they hadn’t told anyone they were depressed. I tried to find out more by reading the full article published in The Journal of Neuroscience, but couldn’t find it in the issue that was referenced and there was no further information on the UIC website. 

 I was also concerned by one of Dr Mark Rasenick’s (UIC) comments:

 “In simple language — we may be able to tell you if you are depressed..”.  

My immediate reaction was that my clients know they are depressed and don’t need to be told. We currently define depression in accordance with the DSM4 criteria, which is based on how a client/patient feels. It looks at factors such as depressed mood, loss of interest or pleasure, poor concentration, lack of energy etc. All these are based on the subjective experience of the patient. The patient may not know that what they are feeling is depression (although these days increased awareness means that many of them have a good idea), but it is their description of their experience that creates the diagnosis. 

Dr Rasenick seems to be suggesting that in the future we will be able to carry out a test to see if you are depressed or not. If the test is negative, then ‘good news, you’re not depressed’, so all those negative thoughts and emotions you are experiencing must be your imagination. If it’s positive then ‘congratulations you do have depression’, take some antidepressants and you’ll feel fine. I’m sure the study team didn’t intend for their work to be interpreted quite in this way, but there is no attempt made to explain what Dr Rasenick does mean. Is he suggesting that there will be two conditions one where depressed mood etc. occur together with these ‘biomarkers’ and one where the DSM4 criteria are met and there are no biomarkers? This might actually be quite useful as it might indicate whether or not your depression is likely to be helped by antidepressants or similar treatments. However, a test that denied clients experience of depression because there was no physical symptom to detect would be a step backwards. 

Couldn’t we please have a more integrated approach to reporting research and indeed to trying to understand depression? When scientific research throws up biological results like this, why is there never any attempt to integrate them into a more holistic view of depression? Maybe this is down to how the media reports studies, looking for a catchy headline, but I’m sure it would help if the research scientists thought about the wider implications too. It would be so much more helpful to patients and professionals alike if we could start to bring all the information together and try to create a consistent theory. Instead we seem to be stuck with each group working within their own model with little attempt at integration.   

Read the UIC Press Release here.

Media articles stating that depression is caused by chemical imbalances in the brain are not backed up by scientific evidence.  This is the finding of Jeffrey Lacasse and Jonathan Leo who spent about a year monitoring such news items. They contacted the authors of articles to ask for the scientific evidence to back up what they had written. None were able to do so satisfactorily. This is hardly surprising, as there is no definitive evidence to back up the chemical imbalance theory. (click here for the full story).

The idea that depression is caused by chemical imbalances was developed in the 1960’s when it was observed that some people seemed to show an improvement in their symptoms after taking certain drugs. However, there has never been any definitive evidence to show that levels of chemicals such as serotonin are directly related to depression. The use of antidepressants is based on this unproven theory and there is increasing debate as to whether antidepressants actually work (see last week’s blog entry). The reality is that we still don’t know what causes depression. Current theories include serotonin imbalance, genetics, stress, psychological factors, social factors, spiritual crisis and various combinations of these factors. 

So why don’t media articles reflect this situation? Is it just laziness? Could it be that journalists receive press releases from pharmaceutical companies and just assume they are correct, without bothering to check the facts? Those with a vested interest in the chemical imbalance theory have a lot of money and are well placed to saturate the media with their version of reality. Or maybe it’s because headlines such as ‘Depression caused by chemical imbalances’ or ‘Antidepressants don’t work’ are more likely to cell papers than the more accurate or ‘We Still Aren’t Sure What Causes Depression’ or ‘Lack of Evidence of Clinical Effectiveness of Antidepressants Compared to Placebos’.

If our understanding of depression and hence our ability to treat it is to improve then the media need to start presenting a more balanced picture. Perhaps we can all play our part by speaking out and making sure that the media are aware of the alternative views and challenging articles which we know are misleading.  I don’t know what causes depression, but I do know that the truth is best served by open debate and genuine enquiry.

The latest study from the University of Hull suggests that antidepressants are no better than placebos for those with mild to moderate depression. This is a topic that is hotly debated and one I have touched on in my book. This latest study is significant because it has included certain trials that had not previously been available (unpublished trials). In total the team reviewed 47 clinical trials.

As usual the drug companies are quick to criticise the study. However, it has long been argued by some that drug companies keep quiet about the trials that show their products in a bad light. How are we to know if this is true or not? Can we have any confidence in studies that don’t have access to all the data?

Although the latest study certainly adds weight to the arguments against the use of antidepressants, it shouldn’t change the current NICE recommendation, as this already states that antidepressants should not be the first treatment of choice for mild to moderate depression. It does raise some really interesting questions about the power of placebo. If people can experience dramatic improvements when taking a drug that should have no significant effect then this suggests that the placebo effect may be worth harnessing. However, in order for a placebo to work it would have to be marketed as an actual drug, which raises enormous ethical dilemmas. Would you rather be lied to and take an inactive placebo with no side effects that made you feel better because you believe it will, or take an active drug of disputed effectiveness, that has side effects and also makes you feel better because you believe it will?

As I suggest in my book we still don’t understand the causes of depression and it may turn out that antidepressants do help certain people with depression, but not others. This could explain why studies can show such varying results. However, as the weight of evidence swings against antidepressants it is well worth exploring the other options available to you such as counselling, exercise, diet and yoga.

A recent report from the Associate Parliamentary Food and Health Forum has provided more support for the idea that some depression may be linked to low omega 3 intake. The Report looks at the link between nutrition and mental health generally, but the conclusions on depression in section 3 are of particular interest. Although more research is needed I would strongly recommend that anyone suffering from depression makes sure that they are not deficient in omega 3.  Omega 3 is good for your health generally anyway, so there is really no down side. You can either take supplements or make sure that you eat foods high in omega 3 (or both). For non vegetarians that means plenty of oily fish and for vegetarians the best source is flax seed oil.

 You can read the full report for yourself here.

The aim of this blog is to keep you updated on information about depression that has come to my attention since the publication of THE DEPRESSION TRAP. There are new articles being published on depression almost every day, some containing useful new informtion, but others mis-reporting and adding to the confusion. I can’t promise to cover everything, as there is simply too much material, but I will aim to address the more important new discoveries, studies and ideas.

The Depression Trap was officially launched on 18 February at a charity launch party in Wokingham Town Hall. The evening was a great success with over £150 raised for the Depression Alliance. You can view the photos here.

The next phase of our launch is to find new places to sell and market the book both online and in local bookshops. So far I have arranged for it to be stocked in Bookends in Wokingham, plus it is available on Amazon. On the marketing side I am concentrating on online marketing and networking for the next month or so. Please let me know if you have any ideas.

As a first time author receiving my first order over the internet was very exciting. I am now looking forward to my official book launch on 18 February. This is taking place at Wokingham Town Hall and there are a few tickets left if you are interested in coming along. All profits from the evening are being donated to the Depression Alliance. Entrance is free, but there will be a raffle and of course, copies of my book on sale. Light refreshments will be provided and someone from the Deperssion Alliance will be giving a short talk.