It is mid December, and while our warm weather may be deceiving, it is almost time for a new year! This week, Dr. Kalidas shares some pearls on depression. In addition to reviewing basic practices, we discuss several supplements that have been used to beat the blues.

Diagnosis 

Prior to delving into treatment options, lets define depression. The diagnostic criteria for Major Depression Disorder (MDD) includes the following:
• Depressed mood or loss of interest or pleasure in daily activities for more than two weeks
• Mood represents a change from the person’s baseline
• Impaired social, occupational or educational function
• Specific symptoms, at least 5 of 9 of the following criteria should be present:
1. Change in SLEEP. Either hypersomnia (increased sleep) or insomnia (inability)
2. Decreased INTEREST or pleasure in most activities, most of each day
3. Feelings of guilt/worthlessness
4. Fatigue or loss of energy
5. Decreased concentrations
6. Change in activity: Psychomotor agitation or retardation
7. Significant weight change (5%) or change in appetite
8. Depressed mood or irritable most of the day
9. Suicidality, or thoughts of death or suicide
While many people may experience mood swings or emotional reactions to life, it is important to remember that depression symptoms last for atleast two weeks, and impair daily function. In 2013, an estimated 15.7 million adults aged 18 or older in the U.S. had at least one major depressive episode in the past year. This represented 6.7 percent of all U.S. adults.

Clinical Evaluation

The symptoms of depression (as outlined above) can be screened with a tool called the PHQ-9 (patient health questionnaire). Prior to making a formal diagnosis, it is prudent to rule out any organic or biological cause of the symptoms. The symptoms of depression can be caused by a variety of conditions, including anemia, thyroid dysfunction, vitamin deficiencies, infectious diseases, hypoxia or endocrine abnormalities. Tests to rule out these conditions may include, but are not limited to, a Complete Blood Count (CBC), Thyroid stimulating hormone, Vitamin B-12, Vitamin D, RPR, HIV test, electrolytes, toxicology tests, dexamethasone suppression test, and Arterial blood gas. Your practitioner, after taking a thorough history, may order some of this testing, depending on what symptoms are present and the clinical context . If you are diagnosed with major depression disorder, there are several treatment options that can be utilized.

Treatment

To begin with, it is important to have someone or a group of people that you can feel comfortably speaking with. Whether this is family, friends or a church group, it is Important to surround yourself with people who can help you during this time.
There are several classes of prescription medications that have been used for the treatment of depression. While they can be efficacious for many patients, most medications take nearly one month to show their effects. In addition, common side effects of many antidepressants include GI disturbances and decreased libido, which is a deterrent for some patients. It is imperative to keep track of antidepressants that you are taking and their dosages, as some serious and life threatening conditions can occur. The supplements discussed below have shown clinical improvement in patients with depression., We urge everyone to consult with a licensed medical provider prior to using any of these supplements, as side effects and adverse interactions with other medications may occur.

SAMe

SAMe (S-adenosy-L-methionine) is a naturally occurring molecule found throughout the body, with high concentrations in the adrenal glands, liver, and brain. A study by Harvard Medical School and Massachusettes General Hospital showed that SAMe was statistically significant in reducing symptoms of depression for 76 patients, as compared to placebo. While other antidepressants take weeks to work, SAMe has shown symptom alleviation in a few days. Side effects include GI disturbance. In addition, the supplement should not be taken for patients with bipolar disorder, as it may exacerbate manic episodes. Doses range from 400 to 1600 mg daily, with small doses taken prior to breakfast, and large doses split between before breakfast and before lunch. Prior to starting any supplement, it is best to consult with your practitioner, to determine the most appropriate plan.

L-Tryptophan and 5-HTP

L-Trypophan, an amino acid, is most famously known to be in you thanksgiving turkey. L-Tryptophan is also a building block of serotonin, an important neurotransmitter. When serotonin levels are low, patients experience symptoms of depression. While wide scale clinical trials have not been conducted, L-Tryptophan has shown its efficacy in many anecdotal cases. Prior to starting L-Tryptophan, one should consult with a physician to ensure safe levels of serotonin.

5-HTP is a byproduct of L-Tryptophan and has anecdotally helped patients with sleep disturbances, depression, anxiety and migraines. 5-HTP is converted to Seratonin with the help of Vitamin B6. Be sure to look for supplements which include vitamin B6, to ensure the most efficacious results. Like L-Tryptophan, it is imperative to consult with a practitioner to ensure proper dose and minimize any interactions.

St. Johns Wort

St. Johns Wort is a naturally occurring plant that has been used to treat mild forms of depression for years. While some evidence based medicine supports its use, other studies have shown that it is no more effective than placebo. Therefore, the evidence is mixed. St. Johns Wort should be carefully taken, as it has been shown to have several interactions with other medications, including anticoagulants and birth control.

The holidays are an exciting time, which can be overwhelming. If you are suffering from symptoms of depression, the first thing to do is approach a practitioner for help. As you can see, there are a several treatment choices, and it is best to consult with an expert who can tailor an appropriate treatment plan to your individual needs. We wish you a happy, healthy holiday season and a smooth transition to 2016!