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Medical Illness and Depression

Depression is a universally understood condition of sadness and despondency. Life has lost its luster and gloom prevails.

Some sadness is an inherent part of weathering life’s misfortunes. People normally recover from such low points and carry on.

Other conditions of sadness may require lifestyle changes such as resolving a rocky marriage, dropping bad habits, or removing oppressive factors from one’s life.

Still other situations may require the counsel of a good friend or priest or minister – someone one can trust and discuss his or her troubles with.

However, sometimes people don’t recover from life’s setbacks. Or they become depressed over insignificant matters or for no reason at all. The feelings of sadness may simply slow them down or can debilitate them to the point where they weep continuously, cannot function in life, or may consider suicide.

Looking for a Medical Cause

When a person remains depressed despite normal efforts to remedy the problem, a physical source of the depression should be considered. This is particularly true in the case of debilitating or suicidal depression.

Physiological causes of depression are so common, in fact, that The American Assn. of Clinical Endocrinologists states, "The diagnosis of subclinical [without obvious signs] or clinical hypothyroidism must be considered in every patient with depression."

Physical sources of depression include:

• Nutritional deficiencies
• Lack of exercise
• Hypothyroidism
• Hyperthyroidism
• Fibromyalgia
• Candida (yeast infection)
• Poor adrenal function
• Other hormonal disorders including:
  • Cushing’s Disease (excessive pituitary hormone production)
  • Addison’s disease (low adrenal function)
  • High levels of parathyroid hormone
  • Low levels of pituitary hormones
• Hypoglycemia
• Food Allergies
• Heavy metals (such as mercury, lead, aluminum, cadmium, and thallium)
• Selenium toxicity
• Premenstrual syndrome
• Sleep disturbances
• Infections including:
  • AIDS
  • Influenza
  • Mononucleosis
  • Syphilis (late stage)
  • Tuberculosis
  • Viral hepatitis
  • Viral pneumonia
• Medical conditions including:
  • Heart problems
  • Lung disease
  • Diabetes
  • Multiple sclerosis
  • Rheumatoid arthritis
  • Chronic pain
  • Chronic inflammation
  • Cancer
  • Brain tumors
  • Head injury
  • Multiple sclerosis
  • Parkinson’s disease
  • Stroke
  • Temporal lope epilepsy
  • Systemic lupus erythematosus
  • Liver disease
• Drugs including:
  • Tranquilizers and sedatives
  • Antipsychotic drugs
  • Amphetamines (withdrawal from)
  • Antihistamines
  • Beta-blockers
  • High blood pressure medications
  • Birth control pills
  • Anti-inflammatory agents
  • Corticosteroids (adrenal hormone agents
  • Cimetidine
  • Cycloserine (an antibiotic)
  • Indomethacin
  • Reserpine
  • Vinblastine
  • Vincristine

The Importance of Exercise

A Duke University study points out the remarkable connection between depression and one’s physical condition. A group of 156 elderly patients diagnosed with major depression were divided into three groups, including one whose only treatment was a brisk 30-minute walk or jog three times a week. After 16 weeks, 60.4% no longer met the criteria for a diagnosis of depression.

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Duke University psychologist James Blumenthal published the results of his team's study in the Oct. 25, 1999, issue of The Archives of Internal Medicine. "One of the conclusions we can draw from this," he said, "is that exercise may be just as effective as medication and may be a better alternative for certain patients.

Daily 30-minute walks are even better and faster-acting, according to a German study.

Nutritional Deficiencies

A particular note should be made about nutritional deficiencies and their relationship to depression. According to the Encyclopedia of Natural Medicine, "A deficiency of any single nutrient can alter brain function and lead to depression, anxiety, and other mental disorders."

However, some nutritional deficiencies are more common than others.

Vitamin B₂ deficiency is not common but can be created, ironically enough, by certain antidepressant drugs called tricyclics. This can lead to further depression.

Vitamin B₆ is commonly very low in people who are depressed. This is particularly true in people taking birth control pills or estrogen in other forms. Those who are deficient in this vitamin normally do well with B₆ supplements.

Vitamin B₉ is called folic acid and is the most common deficient vitamin. Studies have shown that 31-35% of depressed patients have folic acid deficiencies. The most common symptom of folic acid deficiency is, in fact, depression.

Vitamin B₁₂ works along with folic acid in a number of biochemical functions. Deficiency becomes more common over the age of 50. One study showed deficiency rates as follows: Between the ages of 60-69, 24%, ages 70-79, 32%, over 80, nearly 40%. Supplementation of folic acid and B₁₂ often produces dramatic results in people who are depressed because of deficiencies.

Vitamin C deficiency is not particularly common but can occur people with very poor diets or nonexistent intake of fruits and vegetables. Symptoms of a mild deficiency include fatigue, irritableness and "the blues." If not remedied, scurvy symptoms can develop.

Magnesium is a critical mineral used in sending messages along your nerves. By some estimates nearly 75% of Americans do not take in enough to meet minimum requirements. Magnesium deficiencies can result in muscle weakness and irritability.

Another deficiency can occur with amino acids, the building blocks that make up protein. One form of the amino acid methionine is called SAMe (S-adenosylmethionine). SAMe levels tend to be low in the elderly and in depressed people. SAMe supplements have been effective in alleviating depression. A common dosage of SAMe is to start with 1,600 mg a day - either 800 mg twice a day or 400 mg four times a day - for about two or three weeks, or until you start to feel the antidepressant effects. Then one gradually reduces the dosage to 800 mg or even 400-mg a day, based on one's depressive symptoms.

Tryptophan is another amino acid that affects depression. Many depressed people have low tryptophan levels. One supplement, 5-HTP, which contains a form of tryptophan, has been shown in numerous studies to be as effective as modern antidepressants (such as Prozac, Zoloft, and Paxil) for less cost and with fewer and much milder side effects. A standard dosage of 5-HTP is 50-100 mg once or twice a day with meals.

Low fat diets can lead to depression if they are deficient in a specific fatty acid (the building block of fats) called omega-3. Omega-3 is common in certain seeds, canola oil, soybean oil, egg yolks, and cold-water ocean fish. Population studies in different countries have shown that decreased consumption of omega-3’s correlates with increased rates of depression.

More information on the role of nutritional problems in depression.

Thyroid Problems

A study reported in the Feb. 28, 2000, issue of Archive of Internal Medicine revealed that, of more than 25,000 people given blood tests, 9.9% had thyroid problems they probably did not know about. Another 5.9% were being treated for thyroid problems. This means nearly 16% of the population had thyroid dysfunction. Depression is a common symptom of poor thyroid function.

Dr. Broda Barnes, author of Hypothyroidism: The Unsuspected Illness, estimated that as many as 40% of the public may have low thyroid function, much of which is not detectable by modern blood tests. He recommended a simple and more reliable body temperature test.

Dr. Barnes' self thyroid test, discussed in his book, is as follows: You take an old-fashioned mercury-type thermometer and shake it down and put it on the nightstand before going to bed (if you're going to do it on yourself - on someone else just shake it down below 95 degrees before you take the temp). In the morning on awakening, before arising or moving around, the person puts the thermometer snugly in his armpit for 10 minutes by the clock. If the temp is below 97.8, the person likely needs thyroid or, if they're on thyroid, they need more thyroid. The temp should be between 97.8-98.2. Dr. Barnes recommended Armour Thyroid which is natural. Most doctors don't use this test but alternative doctors do. You can get a list of them who will prescribe thyroid based on this test at the Broda Barnes Foundation at 203 261-2101.

A Note on Depression in the Elderly

A staggering number of the elderly are on antidepressant drugs because depression is rampant among the aged. While many factors can be involved – loss of loved ones, poor health, retirement, etc. – a primary cause of this epidemic is nutritional deficiencies. Not only do they eat poorly but they have trouble absorbing a number of vitamins (e.g. B₁₂) as their age increases.

Thyroid problems, as determined by blood tests, have been estimated to affect up to 20% of women over 60.

Lack of exercise, a common problem with seniors, can, as noted above, be a major source of depression.

Nutritional deficiencies, thyroid disorders, and enough exercise should be a top concern in any population of elderly people with "depression."

Summary

A host of physical ailments can lead to a condition of sadness, tearfulness, and hopelessness. These should be suspected and looked for in anyone who is depressed and has a known physical ailment or who experiences severe or unresolving depression.

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