combatting depression

We’re in the middle of winter, and it’s cold and gray outside. Many of us are not feeling our best.

Some of us may feel a kinship with hibernating animals — sleeping more, eating more, gaining weight, dealing with low energy, and feeling uninterested in life. Wait — did I just describe a hibernating animal, or did I list symptoms of depression? The answer is yes to both!

So, what is depression? Why does it happen? And what can we do about it?

DSM 5, the psychiatrist’s bible, describes depression as a medical disorder comprised of a collection of signs and symptoms (mainly sadness and loss of interest in life) that causes significant dysfunction in many areas of life. There are many theories about its causes and treatment. Following is my perspective, which is derived from my training and experience as a psychiatrist and integrative/holistic doctor.

But let’s start with some numbers.

The lifetime prevalence of depression in the US is about 11 percent. It affects people of all ages and socio-cultural backgrounds. Depression is now considered the leading cause of disability worldwide.

The understanding of depression has always reflected the culture of the time. For instance, Freud and other psychoanalysts of the early 20th century believed depression was the result of early childhood experiences. So, psychoanalysis was the treatment of choice then.

In the 1950s, the serendipitous discovery that the anti-tuberculosis drug Isoniazid had the “side effect” of euphoria heralded the era of the “chemical imbalance” theory of depression. For the last 40 to 50 years, we’ve seen an explosion of many different medications, all aimed at treating the chemical-imbalance theory of depression.

But antidepressants have not proven to be effective in treating depression.

Decades of research have not proven conclusively that a chemical imbalance in the brain causes depression. In fact, a major study by the National Institute for Mental Health found that antidepressants were less effective than placebos. The study found that use of anti-depressants for a year resulted in an average remission rate of merely 15 percent.

Clearly, we are missing something. But as science always does, we are finding new reasons for depression and new ways to treat it.

New research suggests that inflammation plays a primary role in causing depression. In fact, inflammation seems to be the root cause of nearly all chronic diseases.

Inflammation is the body’s defense and repair/regeneration mechanism. But unchecked chronic inflammation can cause problems. Inflammation in the body has clear symptoms — chiefly pain. But the brain cannot sense pain. Instead, the brain’s reaction to inflammation can be mental illness such as depression.

In support of the inflammation hypothesis, studies show that inflammation markers (specific proteins, for instance) are elevated in the brains of people diagnosed with depression. Other studies show that using anti-inflammatory medicines can resolve symptoms of depression.

What causes inflammation?

From my perspective, our lifestyle is the main driver of today’s epidemic of chronic inflammation. In fact, some holistic psychiatrists (like Dr. Kelly Brogan) have coined the term “evolutionary mismatch” to explain why we’re seeing such high rates of inflammation today. According to that theory, we are not genetically equipped to deal with what we’re exposed to in today’s world.

Our genetic material evolved over tens of thousands of years. But today our bodies are suddenly faced with thousands of new chemicals — in the food we eat, the air we breathe, and everything in between. The conflict between our genes and our modern environment contributes to our chronically inflamed state.

What is the solution?

Given this hypothesis, it certainly follows that eliminating inflammation treats depression. In my practice, I have witnessed this time after time.

My approach to depression begins by reducing inflammation in my patients’ bodies and lives. I recommend an anti-inflammatory diet that is rich in natural fats. I prescribe strategic supplements and herbal medicines that naturally support the body’s healing mechanisms. In addition, my program involves implementation of a physical exercise regimen, a relaxation response exercise to directly combat stress and its effects, and psychotherapy to address faulty patterns of thinking that can cause inflammation.

Are antidepressants helpful? 

Given the low efficacy and high side-effect profile of many psychotropic medications, my use of them is relegated to second or third line interventions. In some situations, beneficial side effects such as sedation and appetite stimulation are useful during various phases of treatment, especially to provide symptomatic relief. 

But the use of such medications is always combined with lifestyle education and intervention, and a timeline is set for this form of treatment.

Overall, research about depression and its causes is enlightening, empowering and encouraging. Finally,

with regard to mental illnesses such as depression, we can truly say, “Recovery is possible!”

Aruna Tummala is medical director of Trinergy Health, located at 12800 W National Ave, New Berlin, 53151. Click here to learn more.


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