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Depression Information


Symptoms of Depression

The symptoms of depression include:
  • depressed mood (e.g. feelings of sadness or emptiness) most of the day
  • lack of interest or pleasure in most or all activities
  • significant weight loss or weight gain
  • insomnia (inability to sleep) or hypersomnia (sleeping too much)
  • agitation and restlessness
  • fatigue or lack of energy
  • feelings of worthlessness or inappropriate guilt
  • difficulty thinking or concentrating, or indecisiveness

    Note that not all of these symptoms may be present in every case of depression. For an official diagnosis of depression, at least five of the symptoms must be present for two weeks or more. While it's normal to feel sad, tired, bored, or irritable occasionally or in certain situations, a person with major depression experiences these symptoms throughout the day, nearly every day, for weeks or months on end.


    Types of Depression

    The American Psychiatric Association (APA) recognizes many different types of depression. Each of these disorders is defined and their symptoms are described in the DSM-IV - the Diagnostic and Statistical Manual of Mental Disorders - published by the APA.
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    Major Depressive Disorder (or "major depression") refers to what's commonly called "depression" in layman's terms. A person with major depressive disorder has a depressed mood and/or a loss of interest or pleasure in daily activities for at least two weeks, and often much longer. This change in mood negatively impacts the person's functioning at work, in family life, at school, and/or socially. Some people only experience a single depressive episode from which they recover and regain their positive outlook. Others struggle with recurrent depression and experience many periods of depression throughout their life. It's estimated that 10-25% of women and 5-12% of men experience major depression at some point during their lifetime. At any given time, 5-9% of the female population and 2-3% of the male population are struggling with major depression. (See the DSM-IV criteria for major depressive disorder.)

    Dysthymic Disorder (or "dysthymia") is milder but longer-lasting form of depression. People with dysthymia find little joy or excitement in life - but instead feel bored, worried, sluggish, and/or irritable - for long stretches of time. Unlike a major depressive episode, which although severe may only last for weeks or months, dysthymia can persist for years (or even decades in some cases). Adults that developed dysthymia early in life may believe that it's normal to feel depressed all the time, and as a result they often do not recognize the disorder or take steps to treat it. Dysthymia affects about 3% of the population at any given time, and about 6% of all people will experience dysthymia at some point in their life.

    Bipolar Disorder, also known as manic depression, is characterized by extreme mood swings alternating between depression and mania. During the depressed phase, a person with bipolar disorder can experience the symptoms associated with major depression. During the manic phase, however, they experience an elevated mood that can include excessive energy, elation, euphoria, racing thoughts, little need for sleep, impulsivity, overconfidence, and feelings of importance or grandeur. Although mania can be enjoyable, it can also be a destructive force that impairs judgment, causes feelings of being overwhelmed or out-of-control, and leads to inappropriate or reckless behavior such as drug use, spending sprees, or promiscuous sex. In the extreme form, a manic person may lose touch reality and even experience hallucinations. The duration of the manic and depressed phases can vary, with some people cycling between the two in a matter of weeks and others remaining depressed or manic for years. In general, the depression experienced by people with bipolar disorder can be severe, and about 10-15% end up committing suicide.


    Prescription Drug Treatments

    Prescription drugs for depression can be divided into five classes: older drugs such as tricyclics and MAOIs and newer drugs like SSRIs, SNRIs and novel types.

    Older Antidepressants: Tricyclics and MAOIs

    Tricyclic antidepressants (TCAs) are an older class of depression drugs. TCAs can cause side effects such as dry mouth, constipation, bladder problems, sexual dysfunction, blurred vision, dizziness, and drowsiness. Examples include Elavil® (amitriptyline), Tofranil® (imipramine), and Anafranil® (clomipramine).

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    MAO inhibitors (MAOIs) are now the rarest type of depression drugs. MAOIs work by inhibiting the activity of monoamine oxidase, an enzyme responsible for breaking down serotonin, dopamine, and norepinephrine. These three neurotransmitters regulate mood and emotion in the brain, and depressed individuals often have unusually low levels of one or more of these neurotransmitters. ("Neurotransmitters" are chemical messengers used to send signals from one nerve cell, or "neuron", to another in the brain.) By inhibiting monoamine oxidase, MAOIs prevent the breakdown of these neurotransmitters and thus increase their activity. Unfortunately, monoamine oxidase is also responsible for breaking down many other compounds, including certain drugs and amino acids found in common foods. For this reason, people taking MAOIs must be extremely careful not to take certain drugs and must follow a restricted diet. For example, if a person on an MAOI eats foods containing the amino acid tyramine (including beer and wine, aged cheeses, avocados, many fruits, certain beans, sour cream and yogurt, and chocolate), an excess of tyramine will build up in their body and they may experience hypertensive crisis.

    Because TCAs and MAOIs pose serious safety risks and frequently cause side effects, they have fallen out of favor with physicians and patients and are now rarely prescribed. Today, most people taking antidepressant drugs take newer medications such as selective serotonin reuptake inhibitors (SSRIs).

    Selective Serotonin Reuptake Inhibitors (SSRI)

    The most significant advance in pharmaceutical treatments for depression came in 1988 with the release of Prozac® (fluoxetine), the first in a new class of antidepressant drugs called selective serotonin reuptake inhibitors, or SSRIs. The release of other SSRI drugs such as Paxil® (paroxetine) and Zoloft® (sertraline) followed within a few years, and SSRIs quickly became more popular than the tricyclic and MAOI drugs used for depression since the 1950's. Both doctors and patients preferred SSRIs over the older antidepressants because SSRIs are both safer and less likely to cause side effects.

    It soon became clear, however, that SSRIs do pose certain safety risks and have their own set of side effects:
  • Sexual dysfunction: Between 40-80% of people taking SSRIs experience some degree of sexual side effects, ranging from diminished libido to anorgasmia (i.e. inability to orgasm) and male impotence.
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  • Weight gain: While most people taking SSRIs don't gain more than a few pounds, a significant portion of those taking the drug put on 20-30 pounds during the first few months of treatment. In these cases, it can be difficult to lose the weight until the drug is discontinued.
  • Sleep problems: About 15-20% of patients taking SSRIs report significant insomnia, twice the rate reported by those taking placebo. To control this side effect, 22-34% of people on SSRI drugs also take prescription sedatives as sleep aids.
  • Increased risk of suicide: In the past few years, a number of studies have suggested that SSRI drugs can significantly increase both suicidal thoughts and the risk of actual suicide. A 2003 review of studies performed by the U.S. and British governments found that taking an SSRI antidepressant increased suicidal behavior and thoughts by 283% in children aged 7-18. And a 2004 study that analyzed the records of 3 million British patients of all ages concluded that patients in the first nine days on an SSRI were 4x more likely to engage in suicidal behavior and 38x more likely to actually commit suicide than patients who had taken the drug for three months or longer. That said, the link between SSRIs and suicide is still being debated among scientists and the magnitude of the risk is not yet clear. Moreover, it's important to remember that depressed individuals in general are more likely to commit suicide, and any increased risk of suicide during the first few weeks of treatment may be offset by a reduced long-term risk. Although the vast majority of people taking SSRI antidepressants do not have suicidal thoughts, the potential risk should be carefully considered, especially for teens.
  • Withdrawal: SSRI antidepressants do not produce a "high" and are not considered addictive, but many users do report uncomfortable withdrawal symptoms when they stop taking the drug. The symptoms of SSRI withdrawal, which for some people can be severe and may persist for a month or more, can include anxiety, insomnia, dizziness, headache, chills, fatigue, vomiting, and diarrhea. To reduce the likelihood of withdrawal symptoms, those who wish to stop taking SSRI antidepressants should wean off the drug gradually by tapering down the dose over many weeks.
  • Other commonly reported side effects of SSRIs include nausea, headache, weakness and fatigue, and diarrhea.

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    Although SSRIs remain the most frequently prescribed medications for depression, their high potential for problematic side effects such as weight gain and sexual dysfunction has led an increasing number of physicians and patients to turn to natural/alternative medicines for depression relief. In the past, doctors and educated consumers had legitimate concerns about the effectiveness of natural remedies: Because the supplement industry is unregulated, it's filled with low-quality products marketed using unproven claims. But a new generation of pharmaceutical-grade natural antidepressants offer ingredients backed by solid clinical research manufactured according to strict quality-control standards, and they're far less likely to cause side effects like sexual dysfunction and weight gain. The leading product in this class is AmorynTM, a popular depression supplement that contains hyperforin, a natural reuptake inhibitor proven to effectively relieve depression in over 30 clinical trials. Surveys show that most users who have taken both prefer AmorynTM over SSRIs or other prescription antidepressants (see graph), suggesting that the popularity of these new "pharmaceutical-grade" depression supplements will continue to rise.

    SSRIs work by increasing the activity of serotonin, a neurotransmitter in the brain that regulates mood and emotion. ("Neurotransmitters" are chemical messengers used to send signals from one nerve cell, or "neuron", to another in the brain.) SSRIs are called "selective serotonin reuptake inhibitors" because they block, or inhibit, the reuptake transporters responsible for collecting and recycling serotonin. By blocking the action of reuptake transporters, SSRIs decrease the amount of serotonin removed from the synapse (the gap between two neurons across which neurotransmitters move), thus increasing the amount of serotonin that remains available to stimulate the postsynaptic neuron (the neuron being activated by serotonin). (For more detailed information, see Wikipedia's entries on SSRIs and serotonin transporters and About.com's article on neurotransmitters .)

    Like most antidepressant drugs, SSRIs do not work immediately but become effective gradually over many weeks. In general, SSRIs start working after about a month and may take 2-3 months to become fully effective.

    In the United States, the following SSRI antidepressant drugs are available (brand name in parentheses):
  • citalopram (Celexa®)
  • escitalopram (Lexapro®)
  • fluoxetine (Prozac®)
  • fluvoxamine (Luvox®)
  • paroxetine (Paxil®)
  • sertraline (Zoloft®)

    Serotonin Norepinephrine Reuptake Inhibitors (SNRI)

    Serotonin norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs in that they work by inhibiting the reuptake of mood-related neurotransmitters. But in addition to serotonin, SNRIs also increase the activity of norepinephrine. Because norepinephrine is involved in motivation and energy, SNRIs may have a more activating and energizing effect than SSRIs.

    In the United States, the following SNRI antidepressant drugs are available (brand name in parentheses):
  • duloxetine (Cymbalta®)
  • venlafaxine (Effexor®)

    Novel Antidepressant Drugs

    The most popular novel antidepressant drug (meaning that it does not fall into one of the classes discussed above) is bupropion (Wellbutrin®). Bupropion works by increasing the activity of dopamine and norepinephrine, to mood-related neurotransmitters. Unlike other modern antidepressants, bupropion does not affect serotonin. Because dopamine and norepinephrine are involved in the regulation of energy and motivation, bupropion has more of a stimulant-like effect than SSRI drugs.


    Natural Treatments

    St. John's Wort
    The natural depression remedy supported by the strongest evidence is hyperforin-rich St. John's Wort extract. Over 30 controlled clinical trials have shown that high-quality St. John's Wort effectively relieves depression. In fact, studies comparing St. John's Wort to prescription antidepressants (including Paxil® and Prozac®) have found that it works just as well as these drugs, but with fewer side effects. With this in mind, most people should turn to high-quality St. John's Wort extract as their first choice for a natural depression treatment, starting with a dose of 600-900mg daily and increasing to 900-1800mg per day if necessary. According to the research, a compound called hyperforin is responsible for the antidepressant effects of St. John's Wort, and only St. John's Wort extracts standardized to contain 3-5% hyperforin effectively relieve depression. Unfortunately, most St. John's Wort products sold in the United States contain little or no hyperforin, and as a result provide no benefit for depression. When deciding on a brand of St. John's Wort for depression, it's critical that you choose a product like AmorynTM that is standardized to contain at least 3-5% hyperforin, the clinically-proven amount. Also, keep in mind that St. John's Wort usually requires at least three weeks to begin working, and may not produce its full effects for a month or two.

    SAM-e (S-Adenosyl-L-Methionine)
    Another natural antidepressant backed by scientific evidence is SAM-e (S-adenosyl-L-methionine). The research behind SAM-e isn’t as strong as the evidence for St. John's Wort, but it is nevertheless promising. SAM-e works quickly, and most people start noticing improvement in days rather than weeks. Unfortunately, the active dose of SAM-e, 800-1600mg daily, can cost $100 or more per month, making it far more expensive than other natural options.

    5-HTP (5-Hydroxytryptophan)
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    5-HTP (5-hydroxytryptophan) is a third natural compound shown by clinical research to treat depression effectively. 5-HTP, an amino acid, allows the brain to produce more serotonin, a neurotransmitter that regulates mood and emotion. ("Neurotransmitters" are chemical messengers used to send signals from one nerve cell, or "neuron", to another in the brain.) Low serotonin levels have been linked to depression, and many prescription antidepressants work by increasing serotonin activity. For most people, taking 50-300mg of 5-HTP per day helps improve mood in just a few weeks without causing side effects. Some websites discuss concerns over the safety of 5-HTP, but these misconceptions are unfounded. In fact, 5-HTP has an excellent safety record, and extensive research has shown it to be one of the safest natural depression remedies available. 5-HTP is a good choice for treating depression when used alone, and 5-HTP supplements can be purchased in most vitamin and health food stores. But 5-HTP may work best for depression when combined with another proven remedy such as St. John's Wort. For this reason, supplements like AmorynTM that contain both St. John's Wort and 5-HTP, along with other mood-related nutrients, may offer the best results at the best value.

    Other Options
    Other popular natural cures for depression include herbs such as Ginseng and Ginkgo, amino acids like l-tyrosine and phenylalanine, and certain nutrients including B vitamins such as B6, B12 and folic acid. In general, the evidence behind these remedies is still inconclusive, although Ginseng and Ginkgo have been shown to relieve depression in the elderly.

    Choosing the Right Natural Treatment

    Hundreds of supplements containing herbs, amino acids, hormones, vitamins, minerals, and other natural substances are marketed as natural treatments for depression, but despite the claims of the companies selling these products, the majority deliver lots of hype but little help. But effective and safe natural depression remedies do exist. So how do you recognize which options are worthwhile and which are worthless? You must judge potential treatments according to a few key considerations:
  • Does the product contain an ingredient or ingredients proven to relieve depression by solid clinical research?
  • Are the ingredients provided in the proper, proven dosages?
  • In the case of herbal extracts or other remedies that can vary in terms of potency, does the supplement use ingredients that are standardized to contain a sufficient, consistent amount of the active constituents?
  • Is the product high or low quality? Is it manufactured according to accepted quality-control standards? And does it use pure, potent, premium-quality ingredients?

    First and foremost, worthwhile supplements for depression are those with ingredients proven to relieve depression in well-designed clinical studies. Of the dozens of herbs, amino acids, and nutrients claimed to cure depression, only a handful are backed by credible scientific research.

    In summary, the best natural treatments for depression are those containing proven ingredients in the proper doses and potencies and manufactured with strict quality-control procedures. One excellent choice is AmorynTM, a natural supplement that combines the proven dose of pharmaceutical-grade St. John's Wort extract with 5-HTP, B vitamins, and mood-related nutrients. Click here to learn more about AmorynTM and how it can help improve your mood and promote a positive outlook.

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