Depression has become an epidemic in the United States. According to the National Institutes of Mental Health (NIMH), in 2013, 9.2 percent of adults in the U.S. reported either chronic, low-grade depression, or having had a major depressive episode. Depressive episodes are periods of two weeks or longer experiencing low mood, coupled with other symptoms such as poor self-image, sleep difficulty, loss of appetite, poor concentration, and low energy. Among U.S. adolescents, a disturbingly high rate of 11.2 percent reported having experienced either major depression or low-grade depression lasting two years or more during their lives. Depression has severely impaired the ability of 1.9 million (7.7 percent) to function. According to the World Health Organization, about five percent of the world’s population is depressed.
These statistics do not distinguish between depression that arises for no obvious reason, and what may be referred to as “situational” depression, which occurs in the face of a significant loss or life event, such as the death of a loved one, chronic illness, or divorce. To an extent, depression is a normal and necessary adaptive response to the inevitable changes and phases of life. As diagnoses of depression have steadily increased over the past decades, some question whether this increase (and the ever-expanding range of conditions considered treatable by antidepressants) has been strategically fostered by “Big Pharma” to justify escalating antidepressant prescriptions. Simply spend an evening watching network or cable television, and this theory won’t seem so far-fetched.
However, in recent decades many of the nutritional, lifestyle, social, and environmental factors that strongly influence our ability to maintain a healthy “brain ecology” and adapt to the stress of loss and life changes have become increasingly disturbed. These disturbances contribute to a pervasive decline in mood.
For those who seek treatment, common strategies increasingly include pharmaceuticals, often more than one prescribed in combination. Pharmaceutical antidepressants work by indirect methods to improve the balance of stress hormones such as norepinephrine (a form of adrenaline) and neurotransmitters (brain messengers such as serotonin and dopamine that influence mood, energy, focus, and motivation).
Psychotherapy is another common treatment avenue for depression. The benefits of appropriate psychotherapy can be profoundly and positively transformative and are, without question, a part of any committed approach to the treatment of significant depression.
Depression is Not a Chemical Imbalance
The idea that “depression is a chemical imbalance in the brain” has come to be generally accepted as fact, a medical explanation for depression’s varied symptoms. If this statement is true, then it seems reasonable to apply a chemical (pharmaceutical) solution to the problem of chemical imbalance. However, this statement is inaccurate in that it sidesteps the more precise and clinically important distinction that we humans are biochemical, not chemical beings. Moreover, the misperception that chemistry provides the best answer to biochemical imbalance denies the powerful therapeutic potential of non-drug approaches that have the ability to promote true healing of the mind’s biochemical imbalances. If this were merely a semantic distinction, the extensive field of biochemistry, distinct from that of chemistry, would not have come to exist as it does today.
There is certainly a place for pharmacologic treatment for mood disorders, including depression. However, it is important to note that while pharmaceutical antidepressants have the ability to modulate levels of neurotransmitters and stress hormones, they do not support the brain’s innate ability to attain and maintain balance in this system. Even when pharmaceutical treatment is indicated, and in view of its associated risks and side effects, doesn’t it make sense to also address existing biochemical dysfunction?
Biochemical Treatment of Depression
Given the proper support, the body and mind have an incredible recuperative ability. Humans do not have deficiencies of the chemical antidepressants Zoloft, Wellbutrin, or Elavil. However, we may have imbalances of biochemicals such as serotonin, norepinephrine, dopamine, cortisol, and the underlying mechanisms that naturally support healthy levels and interaction among them.
Elements of a biochemical, “functional” approach to depression may include:
- Nutritional evaluation and optimization, particularly focused on vitamin D, the Omega-3 fatty acids, the family of B-vitamins, amino acids as the raw materials for neurotransmitters, and other vitamin and mineral co-factors for healthy brain balance.
- Functional laboratory evaluation of sex hormones, stress hormones, and neurotransmitters to identify and address imbalances.
- Attention to lifestyle: improving eating habits to stabilize blood sugar, identifying and minimizing exposure to food intolerances, exercising, integrating mind and body through practices such as mindfulness, yoga, Tai Chi, or spending time in contact with nature and the earth.
- Detoxification: improving digestive tract function and microbe ecology, cleaning up one’s personal environment, obtaining guidance and support for identification and detoxification of internal and external toxicants.
- Support for impaired methylation cycles.
What is Methylation?
Methylation is an essential biochemical process that occurs in every cell of the body, billions of times per second. The common currency of methylation is the “methyl group,” a biochemical “widget” that contains one carbon and three hydrogen atoms. These methyl group widgets are used to drive many different biochemical processes through revolving “cycles” of methylation. This is like a biochemical game of poker, during which methyl groups are exchanged and passed around to perform necessary functions.
In the brain, the importance of methylation to healthy mood cannot be overstated. Methylation is involved in making hormones and neurotransmitters (such as melatonin, serotonin, cortisol, epinephrine, and dopamine) that interact to promote a mind-state of serene, alert well-being and tolerance for stress. Methylation is also essential to the necessary metabolism, or the breaking down of hormones and neurotransmitters (such as dopamine, cortisol, histamine, norepinephrine, epinephrine, and glutamate) for elimination. If methylation is impaired, the balance between production and elimination of stress hormones and neurotransmitters is skewed. Mental function and mood are negatively affected by the impairment.
Supporting MTHFR, MTRR and COMT Enzymes
Methylene tetra-hydrofolate reductase (MTHFR), methionine synthase reductase (MTRR), and catechol-O-methyltransferase (COMT) are enzyme systems that act synergistically as brain methylation pathways to promote balanced brain biochemistry. Reduced activity of these enzymes can occur because of inadequate nutritional cofactors required for their function. This can be due to poor diet, nutrient depletion from stress, inflammation or toxicity, or genetic influences. Impairment of these enzymes increases vulnerability to depression (and other disorders such as anxiety, attention problems, and bipolar illness).
With the relatively recent identification of gene SNPs (single nucleotide polymorphisms, or mutations) involving these and other enzyme systems, genetic influences on depression have become more clear. Fortunately, it’s possible to reduce the impact of genetic vulnerability by providing specific nutrient support, targeting the genetic vulnerability associated with the SNP. In this way, the symptomatic expression of depression (and other mood disorders) may be “epigenetically” modified in a positive direction through nutrition and lifestyle. For example, through testing, a person may learn that they received a SNP from both parents for the MTHFR mutation. He/she is significantly more vulnerable (36% according to one study) to depression because this interferes with folate metabolism. The good news is that this genetic vulnerability may be significantly neutralized by an adequate nutritional intake of appropriate nutrients, including folate. It’s like taking a detour around a roadblock.
Nutritional “Antidepressant” Support for Methylation
The amino acid nutrients S-adenosyl methionine (SAMe) and methyl sulfonyl methane (MSM) provide raw material for and broad general support for methylation. Essential co-factors used in these pathways include the B-vitamin folate in the form of 5-MTHF (5-methyl tetrahydrofolate), vitamin B12 (as methylcobalamin), and activated or phosphorylated forms of pyridoxine (vitamin B-6) and riboflavin (vitamin B-2). Additional nutritional methylation co-factors are trimethylglycine (also called betaine) and the minerals selenium and magnesium. For optimal bioavailability, particularly for those with genetic vulnerability to poor methylation, these nutrients must be provided in ready-to-go, partially metabolized forms, as noted above.
Because of the complex interrelationships between these enzyme processes and the nutrient co-factors that support them, it is recommended that nutritional intervention be taken under the supervision of a healthcare practitioner with a background in functional medicine and biochemistry as it relates to methylation and mood.
How’s Your Methylation?
How can you find out if you have a problem with these naturally mood-stabilizing pathways? One of the most obvious indications of methylation impairment is a serum test for the blood protein homocysteine, available from any clinical laboratory. A serum homocysteine level above 8.0 indicates that methylation is not proceeding smoothly. Another indicator is an elevated mean cell volume (MCV) on a complete blood count (CBC). That said, a normal MCV can coexist in someone with an elevated homocysteine level, and not all methylation impairment can be identified through homocysteine. However, with the advent of relatively inexpensive genetic testing, it’s easy to find out if you have SNPs in methylation-relevant enzyme systems (including MTHFR, COMT, and MTRR). Armed with that information, you and your healthcare provider can create a personalized plan for better methylation and mood.
Debra Gibson, N.D. practices naturopathic family medicine in her Ridgefield, CT office. Functional support for depression and anxiety is an area of focus of her practice. She can be reached at (203)-431-4443 or at [email protected]. Visit her blog at www.debragibsonnd.com.