Depression is a state of mind familiar to almost everyone, but this very familiarity becomes problematic when
approaching clinical depressive states. In ordinary usage the word refers to a mood state that in medicine is called dysthemia, as contrasted
with the normal state of euthymia and the opposite state of elation. In psychiatric usage, disorders of mood are called affective disorders;
depression can be such a disease in itself or a symptom of another mental disorder. Normal human responses to some situations may also
include transient depressions.
Major depression occur in 10% to 20% of the world's population in the course of a lifetime. Women are more
often affected than men, by a two to one ratio, and they seem to be a particular risk in the period prior to menstruation or following childbirth.
Relatives of patients with major depression also seem to be at some higher risk of becoming depressed, and about 2% of the population
may have a chronic disorder known as a depressive personality.
Depression is defined by a standard set of symptoms described in the
American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. They are:
- poor appetite and significant
weight loss, or increased appetite and significant weight gain;
- insomnia, or increased sleep;
- agitation, or retardation,
of movement and thought;
- loss of interest or pleasure in usual activities or decrease in sexual drive;
- fatigue and loss of
energy;
- feelings of worthlessness, self-reproach, or excessive or inappropriate guilt;
- diminished ability to think or concentrate,
or indecisiveness;
- recurrent thoughts of death or suicide, or suicide attempts.
Not all of these characteristics occur in each individual who becomes depressed. For purposes of psychiatric treatment, a person is considered to have experienced a major depressive episode if he or she exhibits a loss of interest or pleasure in all or almost all usual activities and shows at least four of the above symptoms nearly every day for a period of at least two weeks. The term depression is often modified by words that imply either some specific factor or some chemical mechanism as the cause of the state.
- Depressions that have been considered as reactions to some loss of or separation from a valued person or object are called reactive (or exogenous) depressions.
- This contrasts with the usually more severe depressions without apparent cause called endogenous depressions, or those accompanied by delusions.
Melancholia, a term once used to describe all depressive states, is now applied only to these most severe forms of depression. As we are dealing with human beings, thank God, such distinctions are not clear-cut.
Two major classes of anti-depressant drugs are commonly used: the tricyclic drugs, employed since the early 1960's, and the monoamine oxidase inhibitors(M.A.O.I.'s). The herbalist should be familiar with these widely prescribed drugs as they impact the prognosis. Both groups seem to block or reduce the effect of herbal nervines and anti-depressants. This is concluded from my clinical experience but has no statistics to back it up.
- The tricyclic's are considered effective in about 75% of depressed patients. Their exact mechanism of action is unknown, but it is believed to involve their effect on the disposition of norepinephrine or serotonin in the brain. These drugs are not stimulants--in fact they often cause sleepiness--and their effects may not be apparent until two or three weeks after the start of treatment. Sleep disorders may then diminish, and a lightening of mood becomes apparent, but continued treatment is needed for six to nine months before use of the drugs ceases.
- The monamine oxidase inhibitors, prevent the formation of monamine oxidase, an enzyme that breaks down amines (catecholamines &indolethylamines) in the brain and intestinal tract. Their effectiveness is attributed to normalizing (raising) the amount of amine in the brain. Because the enzyme ordinarily breaks down food amines that would otherwise raise blood pressure, the body is no longer protected from this effect when the M.O.A.I.'s are used. Patients who are given them must control their diets with extreme care, otherwise they run the risk of severe headaches, hypertensive crises and even death. Because the drugs can also interact with other chemical drugs to cause increases in blood pressure, physicians prescribing them shouldprovide instructions to patients about the necessary precautions. A partial list of things to avoid includes:
- Foods that are rich in tyrosine
- alcohol, especially red wine
- cheese, meat, yeast extracts, herring, broad beans
- OTC nasal decongestants containing phenylephrine or phenylpropanolamine
Actions indicated for the processes behind this condition:
Nervine Tonics are fundamental to any long-term change in the individuals ability to cope with their lives and transform that which must be changed.
Nervine Relaxants may be called for in the short term, or if the depression has an agitated and hyperactive aspect to it. They should not be the stronger herbs as this might trigger a more entrenched depression.
Nervines Stimulants might help, but not predictively. If the therapist concludes that stimulation is appropriate it is better to use the bitter metabolic stimulants.
Bitters will often bring about dramatic changes in the patients experience of themselves and their lives. This highlights the need for holistic perspectives in such conditions.
Anti-spasmodics will alleviate any muscular tension that might manifest as a body expression of the psychological depression. Care should be taken not to use the stronger relaxants. (See above)
Adaptogens help the adrenals in the stress that the whole body is going through.
Hepatics etc. indicated to support the livers' de-toxification work, especially if the patient has been using prescription psycho-pharmaceuticals.
System Support
The nervous system has to be the focus for toning, but focal point for associated symptoms might be a clue that more deep seated issues are starting to manifest. A common site for attention is the liver and the digestive system in general.
Specific Remedies
As far as this author is concerned there are no clear cut specifics. St. John's Wort has a long tradition of use in Europe, and whilst it sometimes gets remarkable results it also sometimes does nothing. It takes time to work, so must be taken for at least a month.
One possible prescription:
- St. Johns Wort - 2 parts
- Oats - 1 part
- Lavender - 1 part
- Mugwort - 1 part equal parts to 5 ml of tincture t.i. d. for at least 1 month
Broader Context of Treatment
The whole gamut of issues touched upon in this chapter must be addressed. From green salads to relaxation, spinal adjustments to changing the music listened to, the list is endless. Exercise is especially important. The Textbook of Natural Medicine (Pizzorno & Murray) suggest the following nutritional supplements:
- B vitamin complex 50 times the recommended daily dose daily
- Vitamin C 1 gram three times daily
- Folic Acid 400 mg daily
- Vitamin B12 250 mcg daily
- Magnesium 500 mg daily