Depression

Although depression is a clearly defined disorder with mental and physical symptoms, unlike other disorders, doctors cannot diagnose it using a blood panel or other form of lab test. Instead, they use carefully developed clinical guidelines as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Depression is distinguished into various forms. The most common are major depressive disorder and dysthymic disorder.

Major depressive disorder (major depression): Major depressive disorder can be very disabling, preventing the patient from functioning normally. A combination of symptoms sabotages the patient’s ability to sleep, study, work, eat, and enjoy formerly pleasurable activities. Some people may experience only a single episode, while others experience recurrent episodes.

Dysthymic disorder (dysthymia): Dysthymia, also known as chronic mild depression, lasts longer than two years. Symptoms are not disabling or as severe as those of major depression, however the patient finds it difficult to function normally and does not feel well. A person with dysthymia may also experience periods of major depression.

Psychotic depression: Psychotic depression is a severe depressive illness that includes hallucinations, delusions, or withdrawal from reality.

Postpartum depression (postnatal depression): Postpartum depression, also known as postnatal depression (PND), affects 10% to 15% of all women after giving birth. This is not to be confused with the “baby blues,” which a mother may feel briefly after giving birth. The development of a major depressive episode within a few weeks of giving birth likely indicates PND. Sadly, many of these women go undiagnosed and suffer for long periods without treatment and support.

Seasonal affective disorder (SAD): The incidence of SAD increases along with the distance from the equator. A person who develops a depressive illness during the winter months with symptoms that go away during spring or summer may have SAD. Accumulating evidence points to vitamin D deficiency as a contributing factor in SAD and in other forms of depression.

Bipolar disorder (manic-depressive illness): A patient with bipolar disorde experiences (oftentimes extreme) highs (mania) and lows (depression) in mood. The frequency at which an individual reverts from mania to depression, and vice-versa, determines where they lie on the bipolar spectrum – a diagnostic tool used to measure the severity of bipolar disorder.

A diagnosis of clinical depression requires that the patient experience at least five of the nine symptoms below, as described by the DSM, for most of the day, nearly every day, for at least two weeks. One of the symptoms must be either a constant feeling of sadness, anxiety, and emptiness, or loss of interest in formerly pleasurable activities. If any of these symptoms affects your relationships and your ability to function at home or work, consult with a health care practitioner qualified to assess and treat depression.

Emotional Symptoms

• Constant or transient feelings of sadness, anxiety, and emptiness
• Feeling restless; may experience irritability
• Feeling hopeless
• Feeling worthless or guilty for no reason; suicidal thoughts may occur
• Loss of interest in activities or hobbies once enjoyed; may lose interest in sex

Physical Symptoms

• Low energy; fatigue
• Disturbed sleep patterns; may sleep too little or too much
• Significant weight loss or gain due to a change in eating habits; either loss of appetite or eating too much
• Difficulty concentrating, remembering details, or making decisions

Read more on Sleep Renewal about Depression

Research spanning the last 20 to 30 years has examined a range of influences that contribute to depression. These include genetics, brain chemistry, early life trauma, negative thinking, one’s personality and temperament, stress, and difficulty relating to others. Moreover, emerging scientific research suggests that metabolic phenomenon such as inflammation, oxidative stress, and hormonal imbalances can cause or exacerbate depression as well.

Impaired Stress Response

When a person experiences stress (whether it’s physical or emotional, internal or external) the body copes through a complex system of adaptive reactions. This response involves the release of glucocorticoids, or stress hormones, which stimulate adaptive changes throughout the body. A stress response is designed to help us confront or escape danger by redirecting blood flow to the muscles, dilating the pupils, inhibiting digestion, and releasing stored fatty acids and glucose (blood sugar) to be used by the muscles. This process is known as the fight-or-flight response. The fight-or-flight response originates in the brain. When the hypothalamus, the brain’s “control tower,” perceives a threat, it sends chemical signals to the brain’s pituitary gland, also known as the master hormone gland. The pituitary gland then sends chemical signals to the adrenal glands, which sit atop the kidneys. The adrenal glands then release the stress hormone cortisol, which triggers many of the physiological responses to danger. Almost all animals share the fight-or-flight response, as it is paramount for survival. Although we were designed to undergo this response on only an occasional basis, modern humans cope with relentless stress. Such things as financial worries, deadline pressures at work or school, emotional challenges, excessive caloric intake, poor diet, obesity, inactivity, and environmental toxins chronically activate the hypothalamic-pituitary-adrenal axis, keeping us in a perpetual fight-or-flight response. The result is an increased rate of cardiovascular disease, diabetes, and mood disorders such as depression and anxiety. The relationship between chronic stress, depression, and anxiety is complex, but incredibly powerful. For instance, the chronic elevation of glucocorticoids (primarily cortisol) caused by chronic stress actually changes the physical structure of the brain.

Chronic exposure to glucocorticoids shifts dendrites, the branches of neurons that receive signals from other neurons, into less functional patterns. Research links this phenomenon with alterations in mood, short-term memory, and behavioral flexibility. Glucocorticoids blunt the brain’s sensitivity to serotonin, the mood-regulating neurotransmitter most often associated with depression. Chronic stress also increases one’s susceptibility to neuronal damage and impairs neurogenesis, the process by which new neurons are “born”.

Interestingly, emerging research suggests that drugs used to treat anxiety and depression may stabilize mood not only by acting on neurotransmitters, but also by regulating the brain’s receptors for stress hormones. These new findings strongly support the importance of controlling the stress response in order to alleviate mood disorders. Indeed, several genetic and epidemiological studies have linked excessive stress, and the inability to adapt efficiently to stress, with increased rates of anxiety and depression. Fortunately, a number of relaxation techniques and coping styles can improve depression, further emphasizing the role of stress in depression. These approaches include Mindfulness-Based Stress Reduction, meditation, biofeedback, progressive muscle relaxation and an integrative health approach that combines relaxation, nutrition, and exercise.

Recent studies suggest some of these techniques influence genetic activity regulating depression. Brain imaging techniques show meditation significantly affects neurotransmitter levels and the activity of various parts of the brain that facilitate relaxation.

Traumatic events and Post-Traumatic Stress DisorderResearch establishes that trauma, such as the sudden loss of a family member, sexual abuse, or war-related traumas, contributes significantly to prolonged periods of depression. The effects are more pronounced when the trauma occurs in childhood; childhood trauma can considerably alter the structure and function of the brain, increasing susceptibility to depression and anxiety later in life.

Social network and personal relationships

Lack of meaningful social contact with others has been linked to depression, while evidence increasingly shows that close personal relationships and social networks positively affect mood and health. Loving relationships, social connection and support, work-related passion and recognition, and a good marriage help prevent depression. Interestingly, it also has been shown that while a good marriage benefits both men and women, it seems to be more important for men from an overall health standpoint.

Neurotransmitter imbalances

Magnetic resonance imaging (MRI) shows that the areas of the brain that orchestrate thinking, sleep, mood, appetite, and behavior function abnormally in depressed patients compared to non-depressed individuals. In addition, an imaging technique called single photon emission computed tomography (SPECT) shows changes in brain blood flow and neurotransmitter activity in the depressed person’s brain. Although imaging technology can identify neurotransmitter imbalances, it cannot reveal why depression has occurred.

Comorbid Conditions

Depression is more common in those with HIV/AIDS, heart disease, stroke, cancer, diabetes, Parkinson's disease and many other illnesses. Research shows a person with both depression and a serious illness is more likely to experience severe symptoms and find it harder to adapt to the medical condition. Studies also show that treating depression in this population may improve symptoms of the co-occurring illness in some instances. Additionally, people dependent on alcohol or narcotics are significantly more likely to be more depressed.

The mainstream view on the cause of depression relies largely on the monoamine hypothesis - a theory proposing that deregulation in neurotransmitter signaling is the sole cause of depression. This has been the ground for the primary utilization of antidepressant drugs in the management of depression for decades. However, this theory fails to take into account various other well-studied causes, and partly explains the poor success rate of antidepressant medications in some cases. Conventional medicine overlooks several important biological factors that influence depression, thereby undermining the likelihood that a holistic strategy will be employed to thoroughly manage a patient’s depression. If left unchecked, aberrations among these underappreciated factors may work together to create metabolic and neurochemical imbalances that provoke mood changes and initiate depression.

Critical omissions from conventional assessment of depression include:

• Hormonal imbalances
• Nutritional Deficiencies
• Oxidative stress and mitochondrial dysfunction
• Insulin resistance and chronic inflammation
• Hormonal influences

Balanced and youthful concentrations of hormones can help control depression, and astute clinicians often find hormonal imbalances in patients with depression. Because a wide range of hormones can influence depression, it is important to discern which hormone(s) may be an underlying factor when considering depression. For example, thyroid function directly affects metabolism and brain function, and low thyroid activity can contribute to depression. Conventional medicine relies on overly broad thyroid lab ranges, failing to recognize many cases of sub-optimal thyroid function. Overt hypothyroidism has been shown to perturb serotonin signaling in the brain, which can contribute to depression. Furthermore, because the brain requires sufficient thyroid hormones to function optimally, a low thyroid hormone status can contribute to overall loss of function and degeneration in the brain, including the areas of the brain that govern mood. Hashimoto’s thyroiditis, an autoimmune thyroid disease, can cause a person’s metabolism to swing between overly active to overly depressed. These swings can mimic the symptoms of bipolar disorder and cause misdiagnosis and inappropriate treatment.

Sex hormones also influence mood and depression. Women are more susceptible to anxiety than men and also experience more depression when they are pregnant, postpartum, premenstrual and menopausal than at other times in life. These general observations have piqued the interest of scientists and given rise to an expanding body of research linking depression with sex hormone imbalances. By now, it is well known that most steroid hormones (e.g., pregnenolone, estrogen, progesterone, testosterone, and DHEA) are neurologically active. In fact, the brain contains large numbers of receptors for DHEA, estrogen, and progesterone. These hormones affect many functions in the brain, including the regulation of mood. In the follicular phase of menses, when estrogen levels are high, women produce more serotonin and experience an improved mood. When estrogen decreases during the premenstrual period, serotonin levels drop, contributing to the negative mood and personality shifts associated with PMS. Likewise, the drop in estrogen during menopause is associated with reduced serotonin production and a negative impact on mood and cognition. This is evidenced by the fact that SSRIs have been shown to improve mood and cognitive function in menopausal women.

In addition, testosterone deficiency has been linked with depression in men, which is not surprising since testosterone plays an important role in brain function, including mood regulation. In studies, select populations of men were more likely to be depressed if their total and/or free testosterone levels are low; these included those with heart disease, HIV/AIDS, and the elderly.

Medical research acknowledges the link between hormonal imbalances and depression; however, conventional doctors rarely evaluate and address hormone status when treating depression. Instead, they frequently dismiss such imbalances as a normal part of aging, while in truth, restoring youthful hormonal status may effectively combat multiple health deficits associated with aging, including mood imbalances.

Medical research acknowledges the link between hormonal imbalances and depression; however, conventional doctors rarely evaluate and address hormone status when treating depression. Instead, they frequently dismiss such imbalances as a normal part of aging, while in truth, restoring youthful hormonal status may effectively combat multiple health deficits associated with aging, including mood imbalances.

Nutritional deficiency or insufficiency

Nutrition plays an essential role in brain function, and poor nutrition significantly increases one’s risk for depression. Dietary nutrients influence nervous system function in multiple ways. Important dietary nutrients include:

B-complex vitamins: B-complex vitamins serve as cofactors for the production of neurotransmitters. Inadequate levels of B vitamins, especially folate, vitamin B12, niacin, and vitamin B6, can disrupt neurotransmitter synthesis. This not only may lead to mood alterations, but also can impact overall brain function, memory, and cognition.

An Optimal balance of omega-3 and omega-6 fatty acids: Fatty acids are critical components of nerve cell membranes and play an important role in neuronal communication. Fatty acid imbalances can impair the transmission of messages between nerve cells, leading to cognitive deficits and mood alterations, including depression.

An Vitamin D activity: A vitamin-D insufficiency, which is very common even among dedicated supplement users, is linked with seasonal depression. Recent evidence suggests that it also may contribute to general depression through its considerable influence on genetic activity, its ability to control inflammation, and other mechanisms. It is important to remember that optimal brain function necessitates all of these nutritional aspects be addressed simultaneously.

Oxidative Stress and Mitochondrial Dysfunction

Brain tissue is particularly susceptible to oxidative damage due to its high concentrations of phospholipids and the exhaustive metabolic rate among neurons. A growing body of research suggests that oxidative stress contributes to depression and other brain-related disorders. This is thought to result from either an increase in damaging reactive oxygen species (ROS), a decrease in antioxidant defense mechanisms, or a combination of the two. These mechanisms become especially important with advancing age. Newer research sheds light on the critical role of mitochondria and neurotransmission and mood regulation. Mitochondria are the “powerhouses” in each cell that generate energy. In an intriguing study, researchers measured the content of mitochondrial DNA within white blood cells in aging patients who were depressed, and in an age-matched group who were not depressed. The subjects with depression had significantly fewer mitochondria than non-depressed controls, leading researchers to suggest, “mitochondrial dysfunction could be a mechanism of geriatric depression”. In a similar study, greater numbers of mitochondria in peripheral cells were associated with improved cognitive function in healthy elderly women. Preliminary research suggests that two nutrients, coenzyme Q10 and acetyl-L-carnitine, which support mitochondrial function, may influence depression. A small study of 35 depressed patients in comparison to 22 healthy volunteer controls showed that plasma CoQ10 levels were significantly lower in the depressed patients. Levels were also lower in treatment-resistant patients, as well as those with chronic fatigue. Several studies of geriatric depression have investigated acetyl-L-carnitine. Acetyl-L-carnitine also has been found to relieve depression and improve quality of life in patients with liver disease and to ease depressive symptoms significantly in patients with fibromyalgia.

Insulin Resistance

Recent data suggest a direct link between insulin resistance and depression. Evidence suggests that a popular glucose control agent, Metformin, may influence psychiatric health. Individuals who are overweight, have suboptimal glucose control, or have diabetes with concurrent depression may find that losing weight and gaining control over their glucose levels eases their depressive symptoms. Scientific literature indicates that for optimal health, fasting glucose levels should fall between 4.0 and 5.0 mmol/l and 2-hour postprandial (2 hours after a meal) glucose levels should not exceed 6.7 mmol/l.

Chronic Inflammation

Several studies support the role of inflammation and immune system deregulation in depression. Studies have found elevated levels of inflammatory cytokines (signaling molecules with which immune cells communicate) in patients suffering from major depression, late-life depression, and in patients who do not respond to SSRIs. These cytokines include the interleukins IL-1beta and IL-6, as well as the cytokines INF-gamma and TNFalpha. Studies show an association between the systemic inflammation marker C-reactive protein (C-RP) and major depression. Moreover, elevated CRP levels are associated with a number of other significant health problems such as cardiovascular disease. Health Renewal suggests that women target a CRP blood level of less than 1.0 mg/L and men target a level of less than 0.55 mg/L. In prospective studies involving patients being treated with recombinant cytokines for immune-related conditions, depression is observed to develop after inflammation initiates several other undesirable metabolic cascades. This has lead some researchers to identify depression as a late-stage consequence of chronic inflammation. Research innovations even suggest that future antidepressant medications may be anti-inflammatory in nature.

Your Doctor at Health Renewal will determine your personal risk & severity through a thorough Integrative consultation and examination. You may be requested to undergo blood tests to determine underlying abnormalities in the body. Based on these assessments a person-specific treatment plan will be designed for you to address your specific symptoms & concerns. Your treatment plan may consist of the following:

Dietary Considerations for Depression

Dietary factors should always be addressed when managing depression, as evidence demonstrates that various aspects of diet can affect the disorder. Individuals with depression may consume too many inflammatory omega-6 fatty acids and saturated fats, so increasing consumption of omega-3's and decreasing consumption of trans-fats, saturated fat, and excess omega-6 fatty acids is recommended. Omega-3 fatty acids and folate both appear to be very important in mood management. Although the role of these nutrients in the diet is important, one should augment the diet with supplements as described below for maximum benefit in addressing symptoms of depression or in trying to prevent a recurrence. As described later in this protocol, omega-3 fatty acids have been shown to decrease susceptibility to depression and may help as an adjuvant therapy. Foods high in omega-3 include deep-water fish such as salmon, mackerel, sardines, and tuna, as well as flax seeds, and some nuts (e.g., walnuts). Evidence suggests that limiting sugar intake to control blood sugar levels is another important approach to depression. This would include addressing hyperglycemia (high blood sugar), hypoglycemia (low blood sugar), or reactive hypoglycemia (low blood sugar that occurs within 4 hours of eating). Reactive hypoglycemia may be more common in people who are not overweight. To address high or low blood sugar, it is important to limit or avoid sugar and refined carbohydrates, eat small meals 4–6 times per day, eat a balance of healthy proteins, fats, and complex carbohydrates, and decrease caffeine. The nutrients magnesium and chromium and practicing relaxation techniques also help manage hypoglycemia. Recent evidence also suggests that an anti-inflammatory Mediterranean Diet may help prevent or manage depression. A Mediterranean diet, which is rich in omega-3 fatty acids and polyphenolic antioxidants, could serve as a foundation to which targeted dietary supplements are added for maximum response. The diet generally includes good quantities of fish, vegetables, unrefined grains, beans or legumes, fruit, and olive oil. It includes moderate amounts of dairy (mostly cheese and yogurt) and red wine, and limits meats to small portions.

Physical activity

Research supports the use of exercise, primarily aerobic or weight training, as a preventive and adjuvant treatment (used in conjunction with medication) of mood disorders and depression. Some studies have found exercise alone is as effective as medication for relieving depression and that exercise can reduce depression recurrence rates

Complementary therapies for Depression

Hormone Restoration

Although some physicians routinely screen for underlying hormonal disorders and/ or imbalances as part of depression management, most typically do not. Instead, they may consider hormonal imbalances a normal part of aging. Also, many ascribe to the philosophy of looking at studies of averages of population data as opposed to individual cases for potentially beneficial therapeutic programs, which can cause patients who may benefit from hormone restoration to go untreated.

Thyroid

Thyroid dysfunction may be a significantly underappreciated cause of depressive symptoms. In one study, thyroid disorders were associated with a much higher likelihood of depression in women. Studies have shown that treating subjects within so-called “normal” thyroid hormone levels may still be beneficial. Similarly, in a study of 225 subjects with treatment resistant depression, augmenting primary antidepressant therapy with thyroid hormone was found to be roughly as effective as adding a second antidepressant medication for providing relief of symptoms.

DHEA

DHEA is an important steroid hormone often referred to as a neurosteroid because it serves a variety of functions in the brain. DHEA levels decrease with age and stress, and people with depression often have low levels of DHEA. In one study, blood samples from women with a history of depression contained lower levels of select neurosteroids, including DHEA, than women with no depression history. Interestingly, experiments showed the women with a history of depression may metabolize progesterone differently than healthy women, reflecting an adaptive effort by the body to compensate for low neurosteroid levels. A number of studies have examined the role of DHEA in depression, with very encouraging results. DHEA therapy also significantly benefited patients with HIV/AIDS and depression

Testosterone

Studies indicate that some depressed men have low levels of testosterone. In addition, several clinical trials have shown that testosterone replacement therapy, usually transdermal testosterone gel, can relieve depression in men with low testosterone, metabolic syndrome, and HIV/AIDS. Aging men should maintain their free testosterone level to stabilize mood and avert other age related diseases, such as cardiovascular disease and metabolic syndrome.

Estrogen

Estrogen is critically important for brain function and linked to depression, especially in perimenopausal or postmenopausal women. Women using estrogen replacement therapy to alleviate menopause symptoms appear to experience reduced depression. In some older women being treated for depression, estrogen replacement therapy may actually improve the effects of conventional antidepressants. Estrogen is thought to prevent depression through its association with serotonin regulation in the brain. Previous studies have shown that estrogen may facilitate the effects of antidepressants by modulating serotonin receptors. This suggests that an estrogen imbalance may dampen the efficacy of antidepressant medications. Further evidence suggests that estrogen promotes neuroplasticity, the process by which the brain adapts structurally and functionally to new stimuli. Disturbances in neuroplasticity may lead to recurrent depression.

Melatonin

Melatonin is a hormone produced in the pineal gland in the brain; it is involved in sleep-wake function and other circadian rhythms. Melatonin decreases with age and some studies link low levels of melatonin with symptoms of depression. Studies of the new medication Agomelatine, which acts upon melatonin receptors in the brain, support melatonin's influences on depression & anxiety.

Depression is a multifactorial condition, and efficient relief requires addressing multiple neurochemical and metabolic imbalances that may underlie mood disturbances. The nutrients listed below are categorized according to their evidence-based mechanisms of action in brain health and mood regulation.

Broad-Range Nervous System Effects

• Omega-3 fatty acids are long-chain polyunsaturated fatty acids found in fish and various oils, such as flaxseed oil. The brain has a high concentration of polyunsaturated fatty acids, which are found mostly in cell membranes. They affect adaptability of the nervous system, nerve cell conduction and function, and neurotransmitter synthesis. Several research models exhibit the influence of omega-3 fatty acids in depression including: (a) dietary studies; (b) nutritional status studies showing positive effects associated with higher omega-3 to omega-6 fatty acid ratios; and (c) intervention studies that look at both eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) taken as a stand-alone treatment and as an adjunct to medication. One investigation showed that adding the omega-3 fatty acid EPA to conventional antidepressant treatment may help to relieve depressive symptoms. Among children with depression, supplementation with omega-3 fatty acids demonstrated “highly significant” effects on symptom scores. In a review article, researchers analyzed results from six published studies and found that omega-3 fatty acids may reduce symptoms of depression among adults as well. Because they are anti-inflammatory, omega-3 fatty acids also reduce the risk of cardiovascular disease, which is highly associated with depression. In fact, the American Heart Association recommends fish oil for both preventing an initial heart attack and for preventing a second attack when one has already occurred. Omega-3 fatty acids are counterbalanced with the inflammatory omega-6 fatty acids. Typically, South Africans consume far too many omega-6's and not nearly enough omega-3's. The ratio of omega-6 to omega-3 fatty acids is very important and a ratio of Omega 6 to omega-3 of less than 4:1 is recommended. Unfortunately with our current diet so high in Omega 6 fatty acids our ratio is more in the line of 10-20:1, which in turn causes more inflammation in our bodies.
• Magnesium
Magnesium is a cofactor for more than 300 enzymes in the body; it is important for blood-sugar regulation, and has a calming effect on the nervous system. Some evidence shows a link between magnesium deficiency and depression, and a recent, comprehensive review suggests that magnesium supplementation might be a viable approach for depressive symptoms. A major hurdle for supplemental magnesium historically has been delivery into the brain. This is a barrier that has limited the ability of typical magnesium supplements to target conditions that arise from within the central nervous system such as depression and anxiety. However, in a recent scientific breakthrough, researchers collaborating from Beijing, Ontario, the University of Texas, and the Massachusetts Institute of Technology have developed a highly advanced form of supplemental magnesium called magnesium-L-threonate.

Magnesium-L-threonate was shown in multiple animal models to not only effectively penetrate deep into the brain, but also to trigger enhancements in learning and memory by optimizing neuronal communication and reinforcing brain structure in key areas of the cortex, the most advanced aspect of the human brain. Since magnesium-L-threonate is readily able to diffuse across the blood brain barrier, while other forms of magnesium are not, it appears to be the ideal form of supplemental magnesium for those with depression of other mood disorders.

Supporting Neurotransmitter Synthesis

• L-tryptophan and 5-hydroxytryptophan (5-HTP) are immediate precursors to seratonin. L-tryptohan is essential for the brain to synthesize serotonin, and several studies have shown that acute tryptophan depletion can cause depression in humans. In fact, some foreign countries license L-tryptophan as an antidepressant.
• Methylation (a biochemical building block process for producing neurotransmitters):
Methylation is a process in which a molecule passes a methyl group to another molecule. Methylation is essential to multiple functions in the body, including the production of neurotransmitters. One can supply raw materials to support methylation reactions by supplementing with S-adenosyl-methionine (SAMe) or by providing metabolic cofactors such as folate, vitamin B12, and vitamin B6. These nutrients are necessary for neurotransmitter production and have other regulating effects.
• S-Adenosylmethionine (SAMe)
SAMe, which can be found in almost every tissue in the body, assists with production of creatine, glutathione, taurine, L-carnitine, and melatonin. Research not only showed that SAMe can benefit depressed patients who do not respond to SSRIs, but also suggested that it might improve memory function.
• Folate
Research shows that low blood levels of folate are associated with depression, and may also be predictive of poor response to antidepressant medication. Because relapse is associated with low serum folate, it is important to maintain folate supplementation for a year following a depressive episode. The form of supplemental folate is important since a considerable portion of South Africans may have a genetic polymorphism that impairs folate metabolism. In fact, mutations in the gene (MTHFR) that converts folic acid into the active 5-methyltetrahydrofolate (5-MTHF) are associated with depression. Therefore, taking supplemental 5-MTHF directly, which can cross the blood-brain barrier, may be more effective in supporting healthy neurotransmission and decreasing potentially neurotoxic homocysteine levels.
• Vitamin B12
Vitamin B12 should always be measured in the event of depression (or any other psychological problems), as a vitamin B12 deficiency can be a reversible cause of various neuropsychiatric disorders. One should also consider whether a vegetarian diet or malabsorption due to celiac disease or gluten enteropathy is a factor in B12 deficiency. Weaker digestion, reduced absorption of nutrients, and hypochlorhydria (inadequate stomach acid needed to break down proteins that contain vitamin B12) are common in the aging population and associated with a B12 deficiency; B12 levels should be tested in an older person with symptoms of depression. Evidence suggests that the methylcobalamin form of B12 may have more beneficial metabolic effects than cyanocobalamin.
• Vitamin B6
Vitamin B6 is a cofactor for the production of most neurotransmitters, but it is particularly important for serotonin synthesis. B6 levels are often low in women taking oral contraceptives and research has shown that B6 supplementation in these women can improve mood. For example, one study showed 22 women who had depression associated with oral contraceptive use and a B6 deficiency saw significant improvement in their symptoms with B6 supplementation. A more recent study examined blood levels of pyridoxal-5-phosphate (P5P), a metabolically active form of B6, in the blood of 251 elderly individuals. The investigators found that deficient levels of P5P doubled the likelihood of depression in this population. Accordingly, when dietary composition was assessed, those with higher daily B6 intakes were less likely to be depressed.

Blood sugar regulation and insulin resistance

Green Coffee Extract- clorogenic acid

• Recent data linked increasing consumption of coffee with a possible decreased risk of depression. In fact, this relationship proved to be dose-dependent, meaning that the more coffee study participants drank, the less likely depression would strike them. These findings were corroborated by a similar study conducted in 2010, which supported the link between increasing coffee consumption and decreased depression risk. Interestingly, this last trial was unable to link caffeine with depression risk, suggesting that other compounds in coffee may be responsible for the mood-elevating effect.

Conventional coffee preparation, which involves roasting the green coffee beans at high temperatures to attain the desired flavor profile, dramatically lowers levels of health-promoting coffee constituents called chlorogenic acids. Chlorogenic acids have been shown in several studies to aid in controlling blood sugar levels; especially those glucose spikes which occur after a high-carbohydrate meal. In a 12-week study, consumption of chlorogenic acid-fortified instant coffee lead to a considerable reduction in body weight when compared to regular instant coffee. As elevated glucose levels and excess body weight are common among depressives, chlorogenic acids may help combat some symptoms of depression tied to insulin resistance and irregularities in glucose metabolism. Green coffee, the primary source of chlorogenic acids, cannot be consumed as a beverage due to its extremely bitter taste. Consuming a green coffee extract standardized to chlorogenic acids is an effective means of obtaining biologically active concentrations of chlorogenic acids. The potential role of chlorogenic acids in mediating the mood boost associated with coffee consumption, and their thoroughly studied antihyperglycemic properties give rise to promising multimodal depression protection.

• Chromium
Chromium has been studied for its role in regulating blood sugar by facilitating the uptake of glucose into cells, and some research indicates that it may be beneficial in depression as well. Chromium may also help regulate blood sugar and cravings for sugar and carbohydrates in relation to seasonal depression.

Antioxidant Effects

• N-Acetyl-cyseine (NAC)
• One of the best-researched antioxidants for depression is NAC. NAC is a precursor to glutathione, one of the body's most powerful antioxidants. Research has found glutathione depletion and oxidative stress in people with depression. Two recent studies showed NAC is a safe and effective adjunctive treatment that improves depression in patients with depressive disorders.
• Alpha Lipoic acid, Vitamins C & E, and Selenium
Although Alpha lipoic acid has not been well studied for depression, it is one of the most effective supplemental antioxidants, since it helps recycle other antioxidants, such as Vitamin C. It also may benefit blood sugar regulation and neurological function, as evidence shows it can help diabetic neuropathy. In general, antioxidants may help buffer nerve cell damage in cases of chronic or recurrent depression, although they also serve other roles in brain health. For example, the antioxidant vitamin C is an important cofactor in the synthesis of serotonin, norepinephrine, and adrenal hormones that mediate stress. Vitamin E can helps protect nerve cell membranes, and low selenium levels are associated with depression.

Additional nutrients

• Vitamin D3 Growing evidence suggests that vitamin D significantly effects depression. This is not surprising in seasonal depression, since the skin synthesizes vitamin D in response to sunlight, which is less available in the winter. However, vitamin D has been found to play other roles in depression. For example, in a study of 7,358 patients age 50 and over with a cardiovascular diagnosis and no a history of depression, low vitamin D levels significantly increased the risk of developing depression. Studies also found that vitamin D3 (cholecalciferol) supplementation can improve symptoms of depression. One well-controlled study of 441 overweight and obese participants showed an association between low vitamin D levels and depression. High dose vitamin D supplementation, for one year showed an improvement in mood. Vitamin D's effectiveness may be related to the high prevalence of vitamin-D deficiency in the general population, its importance in blood-sugar regulation, and its importance in overall regulation of genetic activity.
• Zinc
Zinc is a trace element known to help regulate the nervous system and may be specifically related to depression. Increasing evidence shows that decreased blood levels of zinc are associated with depression, and, in depressed subjects, lower levels of zinc are associated with worse depression. One pilot study of 20 depressed patients also showed that 25 mg a day of zinc augmented benefits of antidepressant medication.
• Inositol
Inositol levels in the brain and cerebrospinal fluid were found to be lower in subjects with depression. One well-controlled trial showed that taking inositol daily helped relieve symptoms associated with depression. Further research on bipolar depression suggests beneficial influences of inositol. Inositol, a second-messenger precursor, has important cellular communication functions in the nervous system. Interestingly, inositol is also involved with insulin signaling and function. It therefore may have more of an effect on overweight or obese individuals, as well as those who are insulin resistant, such as those with metabolic syndrome or women with polycystic ovarian syndrome (PCOS). These findings require further research and replication.

A multi-gene DNA test can routinely be added to assessment of:

• blood cholesterol and
• glucose levels,
• blood pressure and
• body mass index (BMI) as part of Wellness Programs offered by healthcare practitioners.

It includes analysis of variation in clinically useful genes that may contribute to:

• abnormal cholesterol levels,
• homocysteine accumulation,
• blood clotting,
• iron overload and
• inflammation.

Some of these abnormalities contribute to the development of type II diabetes, obesity and hypertension. Oxidative stress, detoxification of carcinogens and oestrogen exposure are also important considerations in this context.

This pathology supported genetic test is performed in conjunction with assessment of any food allergy or intolerances known to be associated with many chronic disorders. The results of the genetic test are combined with clinical indicators and lifestyle factors to identify a combination of risk factors that may lead to disease development or progression, if left untreated.

For all health conditions, the nutraceuticals are individually tailored by the Health Renewal Doctor. The doctor will decide- based on your history, physical examination and blood tests what would be the best for you and your specific needs and/or deficiencies. It cannot be overemphasized that one must not self-medicate. Self-Medicating is done when a person takes prescription medication or nutraceuticals on their own without a doctor's supervision and/or consent. By not having a physical examination and blood testing done by a qualified and practising integrative medical practitioner, you could be not treating vital deficiencies or conditions such as elevated blood pressure, high sugar level, high stress levels (that can lead to adrenal burnout ) and high blood clotting factors that could lead to heart attacks and stroke. In addition, aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. There is no single supplement prescribed to clients as there is no magic bullet that can support all the essential nutrients that one's body needs. Today's food is not functional and we need to supplement in order to maintain optimal bodily functions and nutrition.

Make an appointment to consult with your Health Renewal Doctor who is an integrative doctor and he / she will assist you in determining your risk factors and how best to prevent any problems or conditions that you may be susceptible to. The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments, nutritional supplements and a healthy diet and lifestyle.

The initial medical consultation at Health Renewal will be approximately 45 minutes. As this is a prolonged medical consultation, the initial consultation fee will be R 975 on arrival (for non loyalty programme members) you will have to complete an in depth questionnaire before the consultation so please arrive 20 minutes before the time. During the 45 minute consultation your Health Renewal doctor will obtain a FULL medical history from you to determine your personal risk. A physical examination will be done after which the Doctor will decide which blood tests need to be requested from your local pathology laboratory. If you have a medical aid, these should be able to be claimed as well.

Once your blood results are received, they will then be analyzed by your Health Renewal doctor who will begin working on a unique prescription plan for you with the compounding pharmacy. At your pre-scheduled second appointment 2 weeks later, the results and examination findings will be discussed with you. This will determine what abnormalities or deficiencies exist and you will be advised on your treatment options. These options may range from prescription medications, nutraceuticals, bio-identical hormonal creams / tablets or alternatively to having bio-identical implants / pellets inserted.

In office treatments such as carboxytherapy may also be recommended for certain conditions such as hair loss, erectile dysfunction ED, menopause or PMS. If you need to lose weight our Body Renewal Medical Weight loss program may be recommended. All these recommendations will be summarized on a sheet / print out which you can take home with you. The nutraceuticals offered at Health Renewal are of superior quality (Solgar) and are not rancid nor contain Hg (mercury ) or PCB'S (which is very important for Omega 3 Essential fatty acids EFA's). They are also free of gluten, preservatives, wheat, dairy, soy, yeast, sugar, artificial flavor, sweetener and colour. We have a great professional team made up of doctors, trained and registered nurses and therapists to support you at any time.

1. You are kindly requested to bring any supplements that you are currently taking, along to your consultation. The doctor can check the ingredients in take this into account when prescribing a treatment plan for you.

2. Also, if you have had any blood work done in the past 6 months, please bring the results along to the consultation. Should you not be in possession of the hard copies, please request these results from the lab you visited. Usually your ID number is sufficient.

After the two week follow up, the initial blood results will be discussed and patient specific nutraceuticals may be initiated. A second follow up another evaluation and blood test at 8 weeks is recommended to measure serum improvements in your Lipogram, homocysteine and other essential blood results. Follow up appointments should be very 6 months.

The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments , nutritional supplements and a healthy diet and lifestyle.

• Exercise – If you have depression, or even if you just feel down from time to time, exercise is a MUST. The research is overwhelmingly positive in this area, with studies confirming that physical exercise is at least as good as antidepressants for helping people who are depressed. One of the primary ways it does this is by increasing the level of endorphins, the "feel good" hormones, in your brain.
• Address your stress - Depression is a very serious condition. It's a sign that your body and your life are out of balance. In reality, one of the most important things you need to do is to return balance to your life, and one of the key ways to doing this is by addressing stress.
• Meditation or yoga can help. Sometimes all you need to do is get outside for a walk.
• Eat a healthy diet - Another factor that cannot be overlooked is your diet. Foods have an immense impact on your mood and ability to cope and be happy, and eating whole foods will best support your mental health. Avoiding sugar & grains will help normalize your insulin and leptin levels, which is another powerful tool in addressing depression.
• Spend enough time with family and friends, who have a positive influence on your life.
• Support optimal brain functioning with essential fats - We also strongly recommend supplementing your diet with a high-quality, animal-based omega-3 oil, like salmon or krill oil. This may be the single most important nutrient to battle depression.
• Get plenty of sunshine – Making sure you're getting enough sunlight exposure to have healthy vitamin D levels is also a crucial factor in treating depression or keeping it at bay. One previous study found that people with the lowest levels of vitamin D were 11 times more prone to be depressed than those who had normal levels. Vitamin D deficiency is actually more the norm than the exception, and has previously been implicated in both psychiatric and neurological disorders.

Positive thinking is talking, visualizing and expecting with certainty. Positive attitude brings in more strength, initiative and energy. Positive thoughts lead to positive actions. It gives a boost to our feelings and actions. We should determine or resolve ourselves and take right decisions at the right time and act courageously. “Even if you are on the right track, you will get run over if you just sit there “said Will Rogers.

Positive actions, in return, give a lot of confidence and happiness which are essential for a contented life. Any matter remains the same and it differs on the perspective with which we view things, negative or positive. Interestingly, positive thoughts only give rise to more positive thoughts and it is a chain reaction. “Your attitude, not your aptitude determines your altitude’ said Zig Ziglar.

Here are numerous quotes on positive and develop positive attitude towards life.

• "Surrounding myself with all my positive friends is the best medicine that no doctor can prescribe." - Nishan Panwar
• "Stop thinking you're not good enough. You are beautiful & way stronger than you realize. Stand up for yourself, don't just let people tear you down, because soon enough... You'll start tearing yourself down."- Mckenzie Hassler quotes
• "Laughter is a pleasant sound, it spreads joy all around Whether you're young or old, laughter can be like Magic to our souls, whenever we're feeling sad Laughter can sustain us so that things don't seem Quite so bad, if we give into laughter, it can be like A cure for something that seems impossible to endure So any time your spirits need a lift fill yourself With laughter and you will find, a much happier Person with a peaceful frame of mind." - Ritu Ghatourey
• "Everyone needs a hug; it doesn't matter where, when, or by whom, so here's one just for you!" - Murali Iyenga
• "Sometimes just a few simple words from a good friend can put a warm feeling in your heart." - Nishan Panwar
• "Give up on your need to blame others for what you have or dont have, for what you feel or dont feel. Stop giving your powers away and start taking responsibility for your life." - Ritu Ghatourey
• "Faith, hope, and patience are the key to things getting better. Just give it another day."- Author unknown
• "The mind is a superb instrument if used rightly. Used wrongly, however, it becomes very destructive." - Ritu Ghatourey
• "Sometimes all you need is a hug from the right person, and all your stress will melt away..." - Murali Iyenga
• "Treat others with kindness. You never know what burdens people bear or what they are going through. You may have power to lift their spirits or break them." - Author unknown