Advances in our understanding of depression make it more treatable than ever before.
Dr. Drew W. Edwards and Sean C. Orr, M.D.
April 3, 2020
Depression is a bad disease that happens to good people—young and old. It’s no one's fault really, and it is more common than you might think. In fact, as many as 20% of adults will suffer from depression in their lifetime. Maybe even more shocking is that one in five high school kids report that they have seriously considered, or attempted, suicide. Depression is also highly lethal. More than 15% of people with untreated or under-treated depression kill themselves. For those with Substance Use Disorders, the prevalence of depression and suicide is even higher. But there is good news. Advances in our understanding of this disease have yielded new and improved treatment. Thus, in the hands of a well-trained clinician, depression is highly treatable.
What Causes Depression?
Studies have shown that depression is rarely due to a single event or condition. As with many diseases, some people are more likely to acquire it than others. For example, it is more common among people with chronic illness, individuals who have been traumatized, or those who suffer from chronic pain. And now, scientists have discovered genetically acquired risk factors that may surprise you. Approximately 30% of the US population have a genetic aberration called Reward Deficiency Syndrome. As a result, they have less dopamine in their brain compared to same age cohorts. Dopamine is a brain chemical, or "neurotransmitter," that produces feelings of focus, reward, and pleasure. People who are low dopamine are highly susceptible to depression, stress disorders, and addictive disease.
A PET scan comparing brain activity during periods of depression (left) with normal brain activity (right). The blue and green colors indicate decreased brain activity due to depression. Whereas the yellow colors indicate normal brain activity. (NIDA)
Are there different kinds of depression?
Yes. Major Depression and dysthymia are the most common types. Persistent sadness, hopelessness, social isolation and thoughts of suicide are common symptoms of major depression. The course of a depressive episode can vary. If untreated major depression generally lasts one year.
Dysthymia is a “low-grade” depression characterized by persistent feelings of sadness and worry that last for at least a year. It is less severe in terms of mortality, yet people with this type tend to have low self-esteem, are social withdrawn and pessimistic about their life. They often have low energy, difficulty in school or work, and trouble in relationships. Dysthymia can follow or precede major depression, or be entirely unrelated.
The third type is called bipolar depression, which remains poorly understood. Mood swings between severe bouts of depression and periods of extreme elation, called mania, accompanied by distorted thinking are the most common symptoms of this confounding illness.
Depression also can be categorized based on metabolic deficiencies, inflammatory conditions, traumatic injuries, sleep abnormalities, hormone imbalances, and neurotransmitter deficiencies.
Symptoms of Major Depression and Dysthymia may include the following
intense feelings of sadness on most days
difficulty concentrating
fatigue and loss of energy
negative attitude
feelings of guilt, worthlessness or helplessness
feelings of hopelessness
sleeping problems
irritability
loss of interest in activities that were once pleasurable, including sex
overeating or appetite loss
aches and pains, headaches, or stomach problems
thoughts of suicide, suicide attempts
Diagnosis
Traditionally, the diagnosis of depression was subjective and relied on the honesty of the patient and the clinical acumen of the clinical diagnostician to arrive at an accurate conclusion. This process has been incredibly fraught with error, imprecision, and vagaries. Societal stigma, clinician fatigue, and fear have tainted the process.
Fortunately, with the advent of new tools, we are now able to remove the stigma from the process. Rather than looking at depression as a moral failing, we can feel compassion for the patient who is suffering from its effects for no fault of his or her own. Objective testing is revealing the influence of genetic patterns and structural abnormalities of the brain that contribute to the many symptoms that comprise the diagnosis of Major Depressive Disorder and its many variations.
Source: Korgaonkar, M.S., et al. (2014). Abnormal Structural Networks Characterize Major Depressive Disorder: A Connectome Analysis. Biological Psychiatry, 76, Issue 7, Pages 567–574. DOI: https://doi.org/10.1016/j.biopsych.2014.02.018.
Treatment and Recovery
If you feel that you might be depressed, it's important that talk with somebody right away who will support you and help get you through it. Traditionally, your family doctor is a good and obvious place to start. In many cases, he or she may start you on a medication or refer you to a psychiatrist for further evaluation and treatment.
However, in the quagmire of our broken, “managed care” system, too many physicians practice under the rules set forth by the insurance company and not by the needs of the patient. Why? Remember that health insurance companies are NOT in the healthcare business. They are in the financial investment business and thus incentivized by profit. This means they collect your monthly premium and invest it to make a money for the investors. Dipping into the collectively pooled premiums from the “insured” to payout for necessary diagnostic procedures and individualized and optimal care is not in their best financial interest.
Under this system you can see that medical care is driven by non-medical decision makers whom are ultimately accountable to the financial interests the investors and not the medical needs of those paying their salaries. This makes it almost impossible for physicians to delivery truly high-value precision medicine and is one of the primary reasons why The Neurogenesis Project was conceived. We wanted to provide timely and optimal care for our patients and not be enslaved to the mandates of an investor-driven corporation. In the case of depression, time is critical, as the mortality rate for untreated and undertreated depression is between 15-20%. It’s an understatement to say that we take this disease and the person with it—very seriously.
Accordingly, optimal treatment for depression requires taking the time to understand each patient's medical and genetic history and to rule out other, atypical causes of depression, such as thyroid disease, sleep apnea, trauma, pre-diabetes, hormonal imbalance, and deficiencies of certain vitamins and nutrients, just to name a few. Depression is a multifaceted disease with known genetic risk factors. Thus, a comprehensive evaluation is needed, followed by an individualized, collaborative and multimodal approach to treatment, putting the patient at the center of all activity.
It's important to note that, while traditional treatment for depression typically involves individual counseling and medication, today's medical establishment has awakened to the potential of other solutions, as well. This includes nutritional supplements, certain forms of exercise, and sleep optimization, all of which constitute a formal "Brain Building Program."
• Medications
Medications for depression are thought to work by modulating amount and availability of neurotransmitters, primarily serotonin, norepinephrine, and dopamine, which can restore the balance of neurotransmitters, thus improving your mood. The more modern medications combine their effects and also have been shown to improve synaptogensesis, neuroplasticity, and neurogenesis as mechanisms of action that go beyond neurotransmitter effects. Agents such as ketamine, for example, have been shown to take effect in as little as fifteen minutes in some patients, largely due to these mechanisms of action.
However, most take several weeks before symptoms improve. During that time, though, some of the undesirable side effects of these medications can occur immediately, such as dry mouth, fatigue, insomnia, sexual dysfunction, and anxiety. Some symptoms subside within a week, while others, such as sexual dysfunction, may persist. In some very rare instances, these medicines increase the risk of depression and suicide attempts. Therefore they should only be used under the care and supervision of an experienced medical professional.
• Supplements and Activators
Traditional Medicine has rejected supplementation over the years because so many substandard products have been sold to unwitting patients with little to no oversight or accountability. However, over last decade, the industry has come to recognize that there is a robust market for highly purified nutritional supplements that actually deliver measurable results. Thus, a new category of nutritional supplements has evolved, called "Nutraceuticals." These products deliver vitamins, trace elements, macronutrients, and other natural molecules in ways that create clear, predictable results for people who desire a better level of health and wellness.
Nutraceuticals are manufactured to a higher standard of purity and accountability defined by the USFDA in the Good Current Good Manufacturing Practice (CGMP) Regulations. This means that they are made to the same standard as pharmaceutical products, making them truly high-quality, reliable products for the consumer. As a result, physicians are now finding it possible to recommend certain supplements in order to target conditions such as depression, knowing that their patients won't be wasting their money. Here are our favorite options for people suffering with depression across the spectrum of levels of Brain Function:
NeuroRescue
Breaking the cycle of depression is the first place to start and is absolutely critical in order to reduce the chance of resorting to substance use and self-harm. This starts with normalizing the brain's levels of dopamine with RestoreGen®, a newly patented, novel "neuronutrient" developed by neuroscientists from the University of Texas and the University of Florida. This supplement is designed to increase the bioavailability of the neurotransmitter dopamine in the Mid-Brain and Prefrontal Cortex. Recent clinical trials have demonstrated its efficacy in patients with depression, Addictive Disease and Hedonic Overeating, and there are numerous anecdotal data suggesting it mediates pain and ADHD, as well. It is available without a prescription and has no known adverse effects.
NeuroRecovery
When someone with depression is coming out of a dark tunnel, it's important to continue to help the process of recovery along in order to reduce the risk of relapse. One of the best products on the market for this purpose is Eternal by VASAYO™, which is advertised as an anti-aging product rich in polyphenols. While it may help slow the aging process, it also gives the brain a big assist, as these food-sourced compounds are used to generate new neurotransmitters which are necessary to combat the effects of depression. Eternal contains N-Acetylcysteine, which has a powerful protective effect for the mitochondria, the tiny powerhouses that generate energy for the cells of the brain and body. This solution is great for helping to accelerate the recovery process.
NeuroProtection
Because the brain is so sensitive to physiological stressors, it's important to keep it from succumbing to the myriad insults and harmful effects of pathological inflammation and oxidative damage. This is why we are such a huge fan of Protandim® Tri-Synergizer™. This nutraceutical-grade suite of products is more than just supplements, they are "activators" which switch on beneficial genes that protect your cells. There are countless scientific articles published in the literature about the importance of its ingredients to reduce the damaging effects of oxidative metabolism. It also protects the mitochondria and helps to support the SIRTUIN family of proteins, which regulate the aging process.
NeuroOptimization Ideally, once depression has been overcome, it would be nice to continue to enjoy the effects of the brain working in optimal state, able to shrug off stressors and triggers that might provoke depression again. The energizing drink V3 by VASAYO™ helps to optimize the brain's levels of energy, contributing to better concentration and and focus in people suffering from depression,
NeuroEnhacement
For those whose depression is in remission and are engaged fully with life, VASAYO™ also manufactures Neuro, a powerful, natural supplement which improves focus and concentration. Augmentation of one's own natural abilities is a new form of self-improvement, and this natural form of performance enhancement is a socially acceptable, low-risk way of expanding opportunities. People who have been depressed truly benefit from increasing their purpose and ability to generate more, and we can expect to see more products like this becoming available to a broader market in time.
• NeuroStimulation
This is an exciting new modality of treatment that can have a major impact on reversing the effects of depression by changing the brain's way of processing information. We have entered a new era in the treatment and research of brain disorders, and the application of magnetic fields to the brain can offers relief for many patients who are suffering from this life-altering condition.
Transcranial Magnetic Stimulation is appropriate for patients who do not respond to medications, which can be as much as a third of people with major depression. This modality stimulates brain cells deep in the prefrontal cortex, which has been shown to be the major portion of the brain responsible for causing depression. Remission can be seen in as many as one third of all patients, and many more experience significant reduction in symptoms. It is a quick, comfortable, and non-invasive treatment option that does not require any anesthesia or admission to a hospital. Importantly, it also doesn't lead to systemic side effects, which can be a major improvement for patients who are suffering from dry mouth, sexual dysfunction, or constipation due to medications. This is truly an exciting addition to the toolkit for the treatment of patients with depression!
• Counseling
Counseling for depression varies, depending on the training and skills of the clinician. The best outcomes are associated with professionals who take the time to understand their patients, help reframe their negative thoughts and irrational beliefs, while teaching adaptive coping strategies for stressful situations, troublesome memories, and strained relationships.
Recovery from depression takes time and often occurs in stages. There may be times when the symptoms have all but disappeared and you feel normal once again. However, it is important to continue your treatment to avoid a relapse. Ongoing communication with your doctors about problems, stressors and setbacks are essential.
At its worse, depression will tell you that there is no hope. That’s a lie. With proper treatment, the burdens you bear will become lighter as your old self gradually reappears, and peace and joy re-enter your life once again.
For more information on depression, treatment and recovery: www.TheNeuroGenesisProject.com