Not long ago, depression was considered to be strictly a psychological problem that was either self-treated or, in extreme cases, treated with psychiatric therapy. Today, the medical world recognizes  depression as a very common and  very serious clinical condition. In fact, over 20 million Americans suffer from it and this number has tripled over the past ten years. These days, it is not uncommon for teenagers and even younger children to be diagnosed with clinical depression. Furthermore, depression has been linked to high blood pressure, stroke, heart disease, diabetes, obesity, and even cancer. The fact that depression is now characterized as an epidemic and that many people feel bad on a daily basis is, well, depressing.

What makes depression rather unique is that its diagnosis is largely subjective and the number of reported cases is probably not even representative of the number of people who are actually suffering from the its often debilitating symptoms. Because there seems to be a certain stigma attached to psychological conditions in general, there are most likely millions more who have not taken their depressive symptoms seriously enough to seek treatment or who are too embarrassed or ashamed to report them.

And then there is the issue of treatment. Not unlike many other medical conditions, medical professionals use prescription drugs as the first line of treatment for this disease. As a result, antidepressant medications like Prozac and Zoloft are among the most commonly prescribed drugs on the market, yet their effectiveness appears to dwindle over time and their use comes with a myriad of unpleasant and sometimes harmful side effects, such as severe withdrawal reactions and weight gain. So essentially these drugs are often substituting some symptoms for others. More importantly, these drugs do not address the underlying cause of depression.

Diagnosis
So what causes depression? Most health professionals agree that while the initial cause of depression may be different for each individual, there is a direct link between depression and certain imbalances in brain chemistry. More specifically, in laboratory tests, most people who suffer from depression exhibit decreased levels of key neurotransmitters in the brain, such as serotonin, dopamine, and norepinephrine. While theoretically a medical professional could run lab tests for these specific hormones, the results are not reliable enough to diagnose depression. A more responsible approach, and one that can be used by medical professionals and laypersons alike, is to look for the presence of mental, spiritual, and physical symptoms from the following list:

Mental: increased or decreased levels of activity; insomnia; inability to concentrate or focus; loss of memory; prolonged periods of physical overactivity or inactivity.

Spiritual: indifference to yourself or those around you; decreased ability to enjoy that which was enjoyable; a sense of inadequacy or worthlessness; feelings of extreme sadness, melancholy, dejection or guilt; decreased libido; suicidal thoughts.

Physical: weight loss or weight gain; unexplained physical weakness; persisting feelings of tiredness and lack of energy; increased or decreased appetite.

*These diagnostic criteria are excerpted from The Family Encyclopedia of Health, by Dr. Rajendra Sharma

Medically speaking, four or more of the above symptoms are required to be defined as depression, and these have to persist for longer than a few days. Now keep in mind that one does not need a clinical diagnosis according to these criteria in order to be diagnosed and or treated for depression. This particular standard happens to be a medical one used for the purpose of medical treatment. In other words, a responsible physician would not prescribe medication for clinical depression unless the patient met these criteria.

However, if you realize that you experience feelings of sadness, melancholy, or dejection that are unrealistic or out of proportion to the apparent cause for more than a few consecutive days, you may decide to seek professional help or deal with your condition in accordance with the recommendations described in this article. If you are unsure about whether these criteria apply to you, follow this Internet link and complete the questionnaire found there http://www.spiritualityhealth.com/newsh/items/selftest/item_235.html .

Causes
As mentioned, the possible causes of depression are many. While one school of thought is that depression is strictly an individual’s chosen psychological response to a particular tragedy or traumatic incident in his or her life, there is enough scientific evidence to demonstrate that such events can actually be triggers for the underlying brain chemistry imbalances that are associated with depression. To make things even more complicated, there are several other factors or scenarios that have been shown to bring about the same chemical imbalances. Among these are:

• Inadequate sleep or insomnia
• Hypoglycemia
• Seasonal Affective Disorder (SAD) or lack of exposure to natural sunlight
• Hormonal imbalances or deficiencies (often caused by glandular hypofunction), such as T-3 (thyroid    hormone), cortisol (adrenal hormone), progesterone (sex hormone), and cholesterol (in some studies, low cholesterol has been linked to depression, violent behavior and suicide – see my article entitled Is Your Cholesterol Too Low? at http://www.ingoodhealthinc.com)
• Heavy metal toxicity, such as from lead, copper, mercury, aluminum
• Toxic effects from alcohol, coffee, cigarettes, MSG, aspartame, or any number of other neurotoxins
• Food allergies (this is commonly in the form of a delayed onset or hidden allergy, especially with gluten-containing foods such as wheat products; these allergies are more difficult to diagnose; see suggestions for diagnosis below)
• Prescribed drugs, such as steroids, antibiotics, blood pressure meds, and cholesterol-lowering statin drugs
• Environmental pollutants, such as PCB’s and HFC’s
• Viral, fungal and parasitic infections, including candidiasis
• Nutritional deficiencies, such as in omega-3 fatty acids (e.g., EPA, DHA), folic acid, thiamine (B1), niacin (B3), pyridoxine (B6), selenium, lithium, tryptophan, l-tyrosine, calcium, and magnesium (simple blood tests can be done to rule out some of these deficiencies)
• Chronic or severe stress (which may lead to the nutritional and/or hormonal deficiencies)
• Fibromayalgia or Chronic Fatigue Syndrome

In light of the virtual laundry list of possible causes of depression, you cansee why simply treating the condition with medication would be insufficient in most cases. This does not mean that if you are currently using antidepressant medication prescribed by your physician that you should stop taking it. What you may do is ask your health practitioner if there are any medical reasons why you should avoid any of the alternative or complimentary approaches in the following section. If your doctor advises you not to try any of these approaches without giving you a medical explanation, or does not appear to know or want to know about the efficacy of these approaches, then perhaps you should find another qualified health professional who is more integrative and proactive.

Treatments
Just as there are several possible causes of depression, there are several ways to treat the condition. Unlike with most antidepressant medications, the goal of these approaches is to correct the underlying cause of the condition – the thing that led to the biochemical imbalance to begin with. The following is a list of ways that these imbalances may be addressed. Please note that these suggestions are not intended to be a substitute for the advice of licensed medical professional.

1. Exercise – possibly the most effective and lowest risk approach; promotes the release of endorphins from the brain; promotes feeling of well-being; stimulates production of serotonin and dopamine; helpful in stimulating the lymph system to flush out harmful toxins that are known to cause the underlying chemical imbalances; also associated with improved cardiovascular health, increased strength and physical independence, increased bone density, improved joint integrity, reduced inflammation, reduced blood pressure, reduced risk for diabetes and certain cancers, and many others; is inexpensive and relatively easy once you establish a routine.

2. Address Nutritional Deficiencies – include more essential fatty acids in your diet, especially the omega-3 fatty acids (e.g., EPA, DHA), which play a key role in hormone production; omega-3’s can be found in wild (not farm-raised), cold-water fish like salmon and sardines, flax seed oil, evening primrose oil (avoid taking this if you are also on antidepressants such as Wellbutrin), and free-range eggs; or you can take flax seed or fish oil capsules at 200-400 mg daily; omega-3’s are also associated with a number of other health benefits, such as improved circulation, the promotion of normal heart rhythm, the prevention of blood clots, reduction of inflammation, and the lowering of triglycerides and blood pressure; other nutritional supplements that have been shown in studies to be effective are folic acid (5-10 mg/daily), thiamine (B1 – can be taken with b-complex), selenium (100-200 mcg/day), lithium (dosage varies significantly according to severity of condition), niacin (B3 – take as part of b-complex, except with liver disorder or high blood pressure), lecithin (2 Tbsp/day), B12 (2,000 mg lozenges are best, for production of neurotransmitter acetylcholine), vitamin C (3,ooo mg/day, but not near bedtime), magnesium (for calming affect on muscles – begin with 300 mg and increase until diarrhea occurs, then reduce dosage).

3. Sleep – necessary for production of growth hormone and other key hormones that affect mood; should ideally get 7-9 hours of uninterrupted sleep per night; causes of abnormal sleep patterns are lack of exercise, stress, eating refined carbs/sugar (see section on hypoglycemia below), watching T.V. just before bed, hormonal imbalances (i.e., cortisol, estrogens, melatonin, thyroid related hormones); L-tryptophan (available by prescription) and 5-HTP (300 mg at night) also promote serotonin production (check with health professional for proper dosage and contraindications); there is also a an herbal sleep formula by PhtyoPharmica called End Fatigue Revitalizing Sleep Formula.

4. Eliminate Food Allergens – most common reactive foods are gluten-containing foods, such as wheat and barley; other common culprits may be foods containing cow’s milk, soy, corn, peanuts, MSG, aspartame, and other artificial food additives; avoid suspected foods for 4-6 weeks to determine whether they are a problem; consult with nutritional professional for proper elimination protocol.

5. Manage Hypoglycemia – hypoglycemia is one of the main causes for disruptive sleep patterns; avoiding refined carbohydrates and simple sugars, especially in the 90 minutes prior to bedtime is essential for preventing the hypoglycemic-wake-up-in-the-middle-of-the-night-to-go-to-the-bathroom syndrome (and you thought is was just your small bladder); eat smaller, more frequent meals throughout the day, consisting of 40% carbs, 30% fat, and 30% protein; for more suggestions concerning hypoglycemia, see article on hypoglycemia at http://www.ingoodhealthinc.com .

6. L-Tyrosine – alleviates stress by boosting production of adrenaline; it also raises dopamine levels; do not take with MAO inhibitor; take 500-2,000 mg/day; consult with physician if you have high blood pressure before taking L-tyrosine.

7. Ultra H-3 – a breakthrough product which balances the levels of the enzyme monamine oxidase (MAO) in the brain; if MAO builds up in the brain, it replaces other vital substances such as norepinephrine (a hormone essential to well-being and vitality) and can cause depression and premature aging; Based on over 500 studies of the legendary Romanian Ultra H-3 product, it is a safe and effective remedy for depression when taken for a trial period of at least 3 months. *this recommendation comes from The Fat Flush Plan, by Anne Louise Gittlemen.

8. SAMe – acts as a serotonin reuptake inhibitor and should be used as an alternative to antidepressant drugs; has been proven very effective in several studies for depression at doses of up to 800 mg/day.

9. Adrenal/Glandular Support – glandular extract supplements are very helpful to support the endocrine system and normal hormone production.

10. Avoid Nutritional and Environmental Toxins – such as mercury (found in warm-water and farm-raised fish), MSG, (found in most processed foods), tap water, aerosols, pesticides (non-organic foods), aspartame and other food additives; don’t heat foods in plastic; use a shower filter; avoid harmful electromagnetic frequencies found in electric blankets and minimize cell phone use.

11. Meditate – this may be perhaps one of the most powerful and relaxing practices to incorporate into your life; it forces you to focus on your breathing and has been shown to boost your immune system and promote the production of mood-enhancing hormones; take 10-30 minutes day and meditate or practice yoga (Hatha style is particularly helpful for depression).

12. Get Adequate/Daily Exposure to Natural/Full-Spectrum Light – This promotes the production of serotonin and other key neurotransmitters and hormones that enhance mood; get at least 30 minutes per day of skin exposure to natural sunlight or use a full-spectrum light source inside, such as may be found at Northern Light Technologies http://www.generation.net/northern

13. Emotional Freedom Technique (EFT) – this is a form of acupressure that has yielded some promising results in the area of behavioral issues; for more information, go to www.emofree.com where you can learn about this practice that you can do yourself.

14. Music Therapy – has been shown to have a dramatic effect on mood in several studies.    Seek out a qualified music therapist for help with this one.

15. Socialize – get yourself out there, even if is a bit uncomfortable at first; studies have shown that human interaction is essential for sound mental health and happiness; join social organizations and simply practice being more open and more approachable, if this is an issue for you.

16. St. John’s Wort – this should is only effective for mild cases of depression and should not be used with other MAO inhibitors.

17. Psychotherapy – for chronic or serious cases of depression, this is still a very effective and way to handle it; look for a licensed therapist who is familiar with Adlerian psychology or who has a spiritual component to his/her approach.

Any one of these approaches may be helpful for chronic or even acute depression. You may have to try them one at a time to see what is appropriate for you. In any case, you should consult with a health professional who is qualified to guide you with the particular approach you choose to go with. Depression can be a very serious matter and should be addressed diligently.