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depression

MELATONIN’S EFFECTS ON DEPRESSION AND THE BRAIN

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For those who are unaware, melatonin is a hormone produced deep in the brain (the pineal gland) and helps to regulate our sleep / wake cycle, among other things.  Sunlight hitting the back of the retina shuts down the production of melatonin, while the onset of nighttime will allow the body to release more melatonin.  So what does this have to do with depression?

We’ve all heard of serotonin and the drugs like Prosac and Paxil and Zoloft that affect serotonin use in the brain.  These are generally used to treat depression, but, in a close review of the studies that have been done, their effectiveness over placebo was minuscule.  Of course, in these same studies, the placebo had a powerful effect on the patient’s depression, meaning that anyone responding to these drugs is probably benefiting from a placebo response and not the drug itself.

Melatonin and serotonin are players along the same pathway; thus, what effects one pathway will influence both hormones.  It is for this reason that there is rising interest in drugs that modify melatonin levels to affect depression.  The drug companies know that these current financial blockbuster drugs, if the curtain is ever pulled back, could fall like a house of cards.  So they are looking elsewhere.

The biochemistry is pretty straightforward; there is only a single step between serotonin and melatonin production in the pineal gland.  The pathway starts with the amino acid tryptophan (or 5-HTP, which is the next compound produced and can be very effective for depression or anxiety).  As would be expected, serotonin levels are higher during the day, but production shifts to melatonin as night falls.

So what does this mean?  It ties in stress, sleep hygiene, anxiety and depression into a biochemical pathway.  Stress levels will lead to a rise in cortisol levels later in the day, making it hard to fall asleep.  Problems sleeping may lead the sufferer to be exposed to bright lights when the body really should be producing more melatonin.  Less melatonin production will interfere with the smooth flow through the biosynthetic pathway, leading to depression.

In addition, melatonin levels have been linked to things like migraines, seizures and cancer.  Rest assured that these conditions will be impacted as well.

The bottom line is that stress management and proper sleep are an integral component of any healthy lifestyle.  Sleep medications do nothing to fix the elevated cortisol, and will likely disrupt the synthesis of melatonin, further throwing off the cycle.  Stress needs to be managed with any number of tools available so that sleep patterns can be restored.

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INFLAMMATION LEADS TO DEPRESSION IN ELDERLY

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Psychological problems seem to be everywhere in today’s society.  The knee jerk reaction is to medicate.  The problem with these drugs is that they really don’t hold up to well against placebo.  As a matter of fact, for the vast majority of patients, they are just plain ineffective.

Before we go into the gist of this article, we need to cover some basic neurochemistry.  There are certain amino acids that our body’s use to convert to neurotransmitters.  The most famous of which is probably tryptophan, which the body uses to convert to serotonin.  Tyrosine gets converted to epinephrine and norepinephrine (adrenaline) in the adrenals as well as dopamine in the dopaminergic cells of the brain.  Using this knowledge, you can actually use supplements containing tryrosine and / or 5-hydroxytryptophan (5-HTP) to help manage depression or anxiety.

This particular study takes an interesting look at what inflammation does to these amino acids in the elderly.  The enzyme indoleamine-2,3-dioxygenase (IDO) breaks down tryptophan, keeping it from being used to make serotonin.  Inflammation seem to speed up this enzyme, breaking down tryptophan before it can be used to produce serotonin and help the brain and our moods function better.

The enzyme guanosine-triphosphate-cyclohydrolase-1 (GTPCH1) is required to produce a compound called BH4, which the body then uses to produce, ultimately, tyrosine and the neurotransmitters noted above.

If all this seems a little too complex for dinner conversation, just remember that inflammation is a major player in much of what goes on in our bodies and brains.  Managing any concern or condition (in this particular case, psychological problems in the elderly) needs to incorporate methods to lower inflammation.

This means a plant based diet.  Lowering of omega-6 fatty acids and increased intakes of omega-3.  It means no processed foods.  Exercise.  Stress management.  The list is almost endless. 

The bottom line is that treatment of any psychological problem needs to encompass the entire body to be the most effective it can be.  Anything short of this is not good medicine.

http://www.sciencedirect.com/science/article/pii/S0006322310012783

ST JOHN’S WORT AS POWERFUL AS ANTI-DEPRESSANTS?

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St John’s wort became popular quite a few years ago based on its ability to effectively manage depression.  Further clarification in the medical literature confirmed this ability, but generally for mild to moderate depression.  But how does it compare to prescription meds?

I do need to mention that there was some attempt to disparage use of St. John’s wort because it interferes with some heart medications because it speeds up one of the enzymes that breaks down some heart medications.  So avoid at all costs, right?  These sensational news articles neglected to mention that pretty much every prescription antidepressant on the market ALSO effects these same enzymes.  Conveniently omitted.

First, let’s get something straight.  For the vast majority of patients taking antidepressants, the results compared to placebo just plain suck.  That’s not to say that some patients could not function without them.  But the majority of patients do not benefit beyond a placebo effect.  Of course, the placebo response, when it comes to antidepressant clinical trials, is pretty darn potent.  On the range of 40-50% response rates.

Of course, the placebo does not increase your risk of diabetes (like the SSRIs) or increase the risk of suicidal ideation or in general zone out your brain.

Then, we can compare the effects of exercise and fish oils on depression and overall neurological function, which is again, quite powerful.  Throw in some meditation to boot and you’re well on your way to improving your brain.

This particular study takes an interesting approach.  Few trials of natural agents go head to head against prescription drugs for fear of the FDA coming back at the natural agent and trying to regulate them (saw this early on with red chinese yeast rice).  This study compares the effects of St. John’s wort extract (hypericum) against citalopram (Celexa) for mild to moderate depression.

The results?  The hypericum users had a lower relapse rates than the citalopram users AND the duration of treatment response was 100 days longer in the hypericum group.  Not too shabby.

The only thing I would add would be to make sure you get your herbs from a reputable source and not off of the internet.

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