Treating Depression Symptoms, Including Bipolar, Clinical, and Seasonal Affective Disorder

AM I
DEPRESSED?
Treating depression symptoms,

including bipolar, clinical, and
seasonal affective disorder
A free guide published by University Health News

A FREE GUIDE FROM UNIVERSITY HEALTH NEWS
Table of Contents
Introduction ............................................................................................................. 4
I. Depression Symptoms and Testing ......................................................................... 5
Common Symptoms of Depression .................................................................................................. 4
Less Common Symptoms of Depression ......................................................................................... 6
Depression Test: What It Can Tell You ............................................................................................ 7
II. What Causes Depression? .................................................................................... 8
Depression and the Brain ................................................................................................................. 8
Depression and Genes ...................................................................................................................... 9
Depression Triggers ........................................................................................................................ 10
Diseases That Can Complicate or Mimic Depression .................................................................... 11
III. Depression Types ............................................................................................... 16
Major Depressive Disorder ............................................................................................................. 16
Persistent Depressive Disorder .......................................................................................................17
Psychotic Depression .......................................................................................................................17
Bipolar Disorder (Manic Depressive Illness) ................................................................................ 18
Mixed Episodes ............................................................................................................................... 19
Seasonal Affective Disorder (SAD) ................................................................................................20
Substance-Induced Depression ......................................................................................................20
Depression with Anxious Distress.................................................................................................. 21
IV. How Depression Affects Different People .......................................................... 22
Signs of Depression in Women ...................................................................................................... 22
Signs of Depression in Men ............................................................................................................ 23
Depression in Children ................................................................................................................... 24
Depression in the Elderly ............................................................................................................... 25
V. Diagnosing Depression ........................................................................................ 26
Screening Questionnaires ............................................................................................................... 26
Laboratory Tests.............................................................................................................................. 27
VI. Depression Treatments: Therapy .......................................................................29
Specialists Who Treat Depression .................................................................................................. 29
Choosing the Right Mental Health Professional ........................................................................... 31
Types of Depression Therapy ......................................................................................................... 32
Complementary and Alternative Therapies ................................................................................... 37
VII. Depression Treatments: Medications and Natural Remedies .......................... 38
Depression Medications ................................................................................................................. 38
8 Serotonin Deficiency Symptoms You Can Identify Yourself ..................................................... 41
Natural Therapies for Beating Depression .................................................................................... 44
Depression-Busters: 4 Dopamine Boosters .................................................................................. 45
8 Natural Dopamine Boosters to Overcome Depression .............................................................. 50
New and Experimental Treatments for Depression ...................................................................... 53
When Depression Treatments Don't Work ................................................................................... 54
Cont'd on p. 3
2 | Am I Depressed?
VIII. Living with Depression .................................................................................... 56

Finding Support .............................................................................................................................. 57
Helping a Friend or Loved One with Depression .......................................................................... 57
Preventing Episodes of Depression ................................................................................................ 58
Take the Long View ......................................................................................................................... 57
Be Kind to Yourself ......................................................................................................................... 57
Take Care of Yourself ...................................................................................................................... 59
Relapse Prevention .........................................................................................................................60
3 | Am I Depressed?
Introduction
What is depression? While everyone feels down in the dumps some of the time,
for some, these feelings are more persistent and can have a lasting impact on
their lives. This is depression. It is a physical disease like any other—not simply
laziness or unwillingness to “man up” or “get a grip”.
People who find themselves wondering, “Am I depressed?” and who suffer from
depression symptoms spend a good deal of their time feeling sad, empty, or
irritable. Depending on the type of depression they have, they may also suffer a
host of other physical symptoms including tiredness, difficulty sleeping or
concentrating, anger, low self-esteem, thoughts of death or suicide, disruptions in
appetite, feelings of guilt or worthlessness, and physical symptoms such as
headache or chronic pain. This is just a small sample of what depression can feel
like.
4 | Am I Depressed?
I. Depression Symptoms
Different people experience depression in different ways. Here’s a list of typical
depression symptoms as well as some of the less common symptoms people
might experience when depressed.
Common symptoms of depression

• Feeling sad, down, or blue most of the time
• Loss of interest in activities and hobbies you once enjoyed
• Difficulty concentrating, paying attention, and remembering
• Disrupted sleep (difficulty getting to sleep or staying asleep, or sleeping

too much)
• Change in eating habits (overeating or losing your appetite)
• Fatigue and loss of energy
• Feelings of guilt or worthlessness
• Feelings of helplessness or hopelessness
• Increased alcohol and drug use
• Irritability
• Low self-esteem
5 | Am I Depressed?
• Neglecting your personal care (such as personal hygiene)
• Physical symptoms that don’t respond to treatment (headaches,

stomachaches, and chronic pain, for example)
• Reduced sex drive
• Thoughts of death or suicide
Less common symptoms of depression

• Being highly sensitive to rejection or criticism, while perking up briefly
with positive events
• Eating too much (often craving foods that are rich in carbohydrates such
as ice cream, chocolate, bread, cereal, and pasta)
• Feeling weighed down or heavy
• Sleeping too much
Depression Test: What It Can Tell You

Are you concerned that you or someone you love may be suffering from
depression? The first thing you need to do is talk with your doctor or convince
your loved one to do the same. In the meantime, there are some simple self-tests
that you can complete on your own to see if you are likely to be suffering from
depression.
Try the self-test on p. 6 (“Am I Depressed?”) to find out whether you might need
to seek help. Remember, whatever the results, if you’re feeling worthless, if your
mood is interfering with your life, or if you feel like the world might be better off
without you, it is imperative that you speak with a health care professional sooner
rather than later.
6 | Am I Depressed?
Am I Depressed? YES NO
Do you feel sad, anxious, or “empty?”
Are you sleeping more or less than you used to?
Are you eating more or less than you used to?
Have you lost interest in activities you once

enjoyed?
Do you feel restless or irritable?
Do you have persistent physical symptoms (such as

a headache or stomachache) that don’t respond to
treatment?
Do you have trouble remembering things,

concentrating, or making decisions?
Are you tired or lacking in energy?
Do you feel guilty, hopeless, or worthless?
Do you have thoughts of suicide or death?
If you check off at least five items on this list and you’ve been experiencing these
symptoms for at least two weeks, that’s a sign of depression.
7 | Am I Depressed?
II. What Causes Depression?

Genes, negative life experiences, learned ways of experiencing and interpreting
the world, lifestyle habits, and other physical illnesses all interact in complex
ways to produce changes in the brain that can lead to depression.
Depression and the Brain

If you compare the brain of someone with depression to the brain of someone
who is not depressed, on the outside they look pretty similar. However, when
imaging scans have been used to look inside the brain, discernible differences in
brain activity have been noted in the brains of people with depression,
particularly those with long-term or chronic depression.
People with a history of chronic depression have been found, on average, to have
a smaller hippocampus—a part of the brain that is involved in memory—and a
thinner right cortex, which is involved in mood.
You might have heard that depression stems from a “chemical imbalance,” and
that is partly true. In people with depression, the levels of certain brain
chemicals—particularly the neurotransmitters serotonin, dopamine, and
norepinephrine—are thought to be out of balance. Serotonin regulates mood,
8 | Am I Depressed?
emotion, and sleep. Dopamine affects movement, attention, and feelings of

pleasure. Norepinephrine regulates arousal, sleep, attention, and mood.
Neurotransmitters are chemicals inside the brain that allow brain cells (also
known as neurons) to communicate with each other.
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People with a history of depression have been found, on average, to have a smaller
hippocampus (the part of the brain involved in memory) and a thinner right cortex (mood).
Depression and Genes

Genes are the likely reasons why members of some families are more prone to
mental illness than others. Genes might also play a role in determining how well
a person responds to antidepressant medications and what side effects they are
most likely to develop.
9 | Am I Depressed?
But don’t think that just because you carry genes associated with depression that
you’re doomed to succumb to the disease. Typically, your genetic makeup helps
determine how likely you are to develop depression in the event that other factors
related to the condition arise, but they are by no means are guarantee that you
will or will not become depressed.
Depression Triggers
While feelings and emotions lie primarily in the brain, the rest of the body and its
interaction with the outside world have profound effects on how well the brain
functions. Here’s a rundown of five of the internal and external factors that can
disrupt the brain enough to trigger depression:
1. Stress
Whether we like it or not, stress is a big and ongoing part of life. Stress, in
appropriate amounts, is actually a good thing. Without it, we wouldn’t even
bother to get up in the morning. It also helps us develop effective coping skills,
resilience, and the capacity to bounce back after hardships. But the key is
balance. Just as too little stress leaves us without motivation to do anything, too
much stress for too long can wear us out and lead to illness.
Having an excess of stress hormones can disrupt your brain’s natural chemistry.
Results from animal studies suggest that constant exposure to stress hormones
damages brain cells, making your brain less able to regulate the stress hormone
response.
2. Illness
When your body feels miserable, your mind often follows suit. Anyone who has
ever had the flu knows how down in the dumps you can feel when you’re stuck in
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bed all day, unable to do anything but cough and blow your nose. Now imagine
being sick not for days, but for months or even years.
It’s no surprise that depression is common among people with chronic illnesses—
particularly among those with debilitating conditions like chronic pain, cancer,
diabetes, or heart disease.
In some cases, illnesses such as Parkinson’s disease or multiple sclerosis (MS) or

injuries to the brain caused by physical trauma or stroke can produce depression
simply because the parts of the brain that regulate emotion are affected by the
disease or injury.
But the link between depression and illness goes even deeper than that. It’s
actually a two-way street. Not only are people with chronic illnesses more likely
to be depressed, but depressed people are also more likely to suffer from chronic
illnesses such as heart disease, and they also have a poorer prognosis than those
without depression who have the same illness.
Recent research suggests that whole body inflammation may help explain this
two-way association. Elevated blood levels of C Reactive Protein (C-RP), a marker
for whole body inflammation, have been found to correlate with the number of
depressive episodes suffered by adolescents and young adults. High levels of C-
RP have also been linked with several other illnesses, including heart disease and
cancer. Many diseases associated with chronic body inflammation have also been
linked with depression.
Diseases that can complicate or mimic depression

A number of illnesses have symptoms that can mimic, cause, be a consequence of,
or complicate depression. That’s why it’s important to diagnose the underlying
condition and to be alert for symptoms of depression. Medical conditions that
can cause depression include:
• Addison’s disease
• AIDS
• Brain tumors
• Cancer
• Coronary artery disease
• Cushing’s disease
• Diabetes
• Encephalitis
• Fibromyalgia
• Head trauma
• Heart disease
• Hypercalcemia (high levels of calcium in the blood)
• Hyperparathyroidism (overactive parathyroid glands)
• Hyperthyroidism (overactive thyroid glands)
• Hypothyroidism (underactive thyroid glands)
• Infection with Toxoplasma gondii (found in cat feces)
• Influenza (flu)
• Kidney or liver failure
• Mononucleosis
• Multiple sclerosis
• Parkinson’s disease
• Seizures
• Sleep apnea
• Stroke
• Systemic lupus erythematosus
• Tuberculosis
• Viral hepatitis
• Viral pneumonia
• Vitamin deficiencies (folate, B12, D)
A number of psychological conditions also can stem from, or contribute to,

depression. These include:
• Alcoholism and other substance abuse disorders
• Anxiety disorders—including post-traumatic stress disorder (PTSD),

obsessive-compulsive disorder (OCD), social phobia, and generalized
anxiety disorder
• Eating disorders—including anorexia nervosa and bulimia nervosa
• Personality disorders—including borderline personality disorder
3. Lifestyle
Several studies have linked poor diet with an increased risk of depression. But it’s
not all about your diet. Research has linked overworking with a twofold increase
in the likelihood of depression, and depression and lack of physical activity are
known to also be closely linked. On the plus side, exercise has been shown to help
alleviate depression.
4. Sleep
Sleep is another lifestyle factor
that is known to have an effect on
depression risk. While depression
can disrupt sleep, not getting the
right amount of sleep also can
trigger depression. Studies have
shown that both too little and too
much sleep are linked with
depression. In general, about 7 to
8 hours of sleep per night is
considered healthy for most
adults, although there are
individual differences.
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The relationship between lifestyle and
depression is a chicken-and-egg
Is your depression a result of sleeplessness? If
situation. That is, poor lifestyle habits so, you may be suffering from sleep apnea. One
can lead to depression, and depressed hallmark of sleep apnea is snoring.
people frequently slip into poor
lifestyle habits. When you can barely drag yourself out of bed, it can be
unimaginably difficult to exercise or cook yourself a healthy meal.
5. Drugs
Certain depression medications affect brain levels of serotonin and other brain
chemicals. Other drugs are very sedating. They slow down thinking, making
people feel sleepy, withdrawn, and unmotivated. All this can contribute to feeling
depressed.
It’s not only prescription drugs that have been linked with depression. Use of
illicit drugs also has been shown to increase susceptibility to the disease. The
association between illicit drug use and depression may also be a chicken-and-
egg conundrum because depressed people may be tempted to self-medicate with
illicit drugs.
6. Hormones
Hormones are chemical messengers that regulate various functions throughout
the body. Hormones are produced by the glands of the endocrine system. Their
release in the body is governed by a very sensitive feedback system controlled by
the hypothalamus and pituitary gland in the brain.
When hormones are produced in excess or in too limited supply, certain body
functions won’t work as well as they should. Depression is one of the potential
side effects of a hormonal imbalance.
III. Depression Types

Depression is a complex condition, and it comes in many forms. In order to help
tease apart the different ways depression can manifest and help clinicians choose
the right treatments, the condition is classified into several different types. The
two main ones are known as major depressive disorder (also called clinical
depression or major depression) and persistent depressive disorder, but there are
several other subtypes as well.
Major Depressive Disorder

Major depressive disorder, or major depression, is the most common type of
depression. People who have major depression aren’t just sad for a few days.
Their low mood lasts for at least two weeks, and usually much longer, and is
significant enough to interfere with their thoughts, behavior, and physical health.
Usually, there are other symptoms in addition to low mood, including:
• Appetite changes with weight loss or weight gain
• Sleeping too little or too much
• Trouble with concentration and/or memory
• Unexplained aches and pains
• Fatigue/lack of energy
• Loss of interest in activities that once were pleasurable
• Agitation, restlessness, or irritability
• Feelings of isolation or loneliness
• Feelings of worthlessness, self-hate, or guilt
• Recurring thoughts of death or suicide
Persistent Depressive Disorder

Persistent depressive disorder is a relatively new classification of the condition. A
person is diagnosed with this type of depression when they have at least two of
the symptoms listed above in addition to a depressed mood that lasts for two
years or more.
Individuals who suffer from persistent depressive disorder typically describe

their mood as “low” or “down in the dumps.” Many people with this disorder
suffer from it for so long that they don’t know what it feels like not to be
depressed and may not even realize they have depression, thinking their
symptoms are just part of life.
The condition often begins in adolescence or even childhood, which contributes

to the perception among sufferers that the symptoms are “normal.” Because of
this, many people with persistent depressive disorder may not report their
symptoms to their doctor.
Psychotic Depression
In people who have this condition, depression is accompanied by strange
hallucinations or delusions. Delusions are beliefs, often bizarre, that have no
basis in reality. For example, a woman with psychotic depression might be
convinced that her children have been possessed by demons, that aliens are
controlling her behavior, or that she is being followed by government agents. She
may hear voices that confirm these beliefs. People who have psychotic depression
often recognize that their thoughts are distorted and may try to hide those
thoughts from other people.
Bipolar Disorder (Manic Depressive Illness)

For people with bipolar disorder, life is often a rollercoaster ride. Their moods
may shift radically from week to week between manic and depressed phases.
Manic Episodes
During the high points, people with bipolar disorder may be almost euphorically
happy and full of energy and activity, sleep little or not at all for days on end,
engage in reckless behavior, have intense flashes of irritability, and have
grandiose beliefs about themselves. They may also have racing, disorganized
thoughts and speak almost too quickly to be understood. This is known as a
manic episode. As with psychotic depression, sometimes people in a manic stage
of bipolar disorder hallucinate or have delusions. A somewhat less intense form
of mania is known as hypomania.
Depressive Episodes
During “pure” episodes of depression, the symptoms of bipolar disorder are hard
to distinguish from the symptoms of major depression. The person will often feel
sad, tired, withdrawn, and will have trouble concentrating, sleeping, and eating.
He or she may experience thoughts of worthlessness, guilt, death, or suicide.
Although mania is a defining feature of bipolar disorder, most individuals with

bipolar disorder experience depression far more frequently and for much longer
periods of time than they experience mania. For that reason, people with bipolar
disorder are often initially misdiagnosed as having depression.
Mixed Episodes
Although manic and depressive episodes usually alternate with each other,
doctors now recognize that in some people, bipolar disorder appears as a mixture
of the two states: mania and depression. During these mixed episodes, a person
can experience the elements of mania (such as high energy, physical restlessness,
and impulsivity) at the same time as the symptoms of depression (such as intense
sadness, guilt, or suicidal urges). Not only are mixed states more common than
was once thought, they may be particularly dangerous because the person’s
energy level is high enough for them to act on their negative thoughts, such as
thoughts of self-harm.
Seasonal Affective Disorder (SAD)

Depression that occurs exclusively with the change of seasons is called seasonal
affective disorder, or SAD. Researchers believe that the lack of sunlight in the
winter disrupts the body’s natural internal clock (circadian rhythm), which
determines when you sleep and when you are awake. For some people, lower
vitamin D levels that are more likely to occur in the northern winters may
contribute to the risk for depressive symptoms.
Usually SAD sets in during the winter months and improves by spring, but some
people experience mood swings during the summer months, too. Summer-onset
SAD may be due to malaise brought on by rising heat and humidity. Whereas
people with winter-onset SAD experience a drop in energy, those with summer-
onset SAD tend to be more irritable and anxious. The symptoms of depression
are generally mild in people with SAD, but they return year after year.
Substance-Induced Depression
Use of certain medications and illicit drugs can lead to depression. When this
happens, a person is said to have substance-induced depression. This type of
depression is considered separate from other types because both the cause and
treatment are typically different. In this case, the offending drug, if prescribed, is
discontinued or the dose is reduced. If the drug causing the depression is being
abused, the person will likely require some form of addiction treatment in order
to recover completely. The key to proper treatment is to identify the underlying
problem and correct it.
Melancholic, atypical, and anxious depression

Some researchers distinguish among people with three different types of
depression symptoms and categorize them as having melancholic, atypical, or
anxious depression. It is not clear whether these are truly different forms of
major depressive disorder with different causes and treatments, or whether they
are simply different ways that depression manifests itself among the millions of
people who suffer from it.
Melancholic Depression
Depressed people with the following symptoms are said to have melancholic
depression:
• Drop in appetite and weight
• Poor sleep
• Strong feelings of guilt
• Little or no response to pleasurable events when they are depressed
Atypical Depression
People with this type of depression tend to:
• Gain weight and crave carbohydrates (such as cereal, bread, pasta, and
sweets)
• Oversleep
• Experience heavy sensations in their limbs (leaden paralysis)
• Become less depressed, though only transiently, when exposed to

pleasurable events (mood reactivity)
• Have enhanced reactions to criticism or rejection (rejection sensitivity)
Depression with Anxious Distress

Anxious distress in major depression tends to be accompanied by:
• Feeling keyed up and restless
• Difficulty concentrating due to worry
• Feeling that something very bad may happen
• Worrying about losing control
IV. How Depression Affects Different

People
Depression unquestionably affects people’s lives in many different ways.
Different cultures, genders, and ages experience depression in unique ways.
Signs of Depression in Women

There is a real gender gap when it comes to depression. Women face double the
risk of the condition compared to men, in part due to hormonal differences and
in part because of the way they deal emotionally with stress. Depression often
coexists with other health and mental conditions that have a higher prevalence in
women, such as eating and anxiety disorders and multiple sclerosis.
Signs of depression in women are often different in women than are depression
signs in men, but this may be in part related to men having symptoms that are
not usually considered in the diagnosis of depression, such as outbursts of anger.
Women are more likely to experience anxiety and physical symptoms. They also
tend to overeat and gain more weight. There is a close relationship between
obesity and depression, particularly in women, and doctors may need to screen
for depression more often in obese women.
• Depression related to menstruation, pregnancy, and birth.

Hormones can play an important role in depression. That is why women
can become vulnerable to the condition during times of hormonal upset.
Premenstrual dysphoric disorder (PMDD), sometimes called PMS
depression, can occur in the days before menstruation starts, when
hormonal changes can upset mood and increase sensitivity.
In 3 to 8 percent of American women, symptoms are severe enough during

the premenstrual period to significantly interfere with everyday life.
Symptoms then diminish or disappear after menses has begun.
• Antepartum depression can occur in some mothers-to-be as a result of

the hormone fluctuations of pregnancy and other factors such as the stress
of an unplanned or first pregnancy. It’s especially important to get treated
for depression while you’re pregnant. Without treatment, depression can
hurt both you and your unborn baby.
• Postpartum depression occurs in some women following the birth of a

child, and it brings with it overwhelming feelings of sadness,
worthlessness, and hopelessness. Recent research suggests that as many as
one in seven new mothers experience this condition.
Signs of Depression in Men

Although women face double the risk, depression afflicts millions of men
worldwide, and recent research suggests that men may actually suffer from
depression nearly as often as women but just show it in different ways.
While women tend to turn their emotions inward and feel worthless and guilty,
men tend to reflect their emotions outward, sometimes becoming angry or
aggressive or turning to alcohol or illicit drugs.
Because men are traditionally perceived as the stronger, more stoic gender, they
are more likely to gloss over depression symptoms such as a lack of interest in
life, fatigue, and low self-esteem. They might fear that revealing their condition
will make them look weak or overly emotional to their family, friends, and
colleagues.
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Is depression genetic? Research shows that it may be hereditary, at least to a certain extent.
Depression in Children
Children—especially young children—may have great difficulty articulating that
they are upset. If depression is all they know, they may not even realize that they
have a problem that can be helped. Their symptoms often do not follow the
typical pattern of adult depression. For example, a child might seem bored or
angry rather than sad. Depressed kids also tend to complain of physical ailments,
such as stomachaches or headaches, because they aren’t able to express their

emotions accurately.
Some children’s expression of depression can be so different from that of adults

that experts have proposed a new subtype of depression that more closely fits
that seen in children. This is known as disruptive mood regulation disorder and is
characterized by a mood that is persistently angry or irritable combined with
regular outbursts of temper. This condition is believed to appear for the first time
among children aged six to 18. Some experts suspect that many children
diagnosed with bipolar disorder may be more accurately described as having
disruptive mood regulation disorder, at least until they get older and the true
source of their troubles becomes clearer.
Depression in the Elderly

Age brings wisdom, but it doesn’t always bring contentment. Growing older can
introduce many new stresses into a person’s life, such as getting accustomed to
retirement, moving to a new home, or dealing with the idea that adult children
have less time for them than they would like.
There may be financial concerns after retirement, especially if investments have

lost value and medical bills are piling up. There may be physical limitations from
diseases that are more common with advancing age, such as arthritis, Parkinson’s
disease, or heart disease. There can be grief and sadness that comes with the loss
of friends, family members, or a spouse.
Finally, neurological and other health changes that occur with age can make
people more vulnerable to depression and vice versa. Cognitive decline or
dementia and depression are intimately intertwined in older people. The
symptoms of each can be difficult to tease apart, and one condition frequently
worsens the other.
V. Diagnosing Depression
Once you approach your doctor about the possibility that you might be
depressed, he or she will likely ask you several questions about how you have
been feeling over the past weeks, months, and years. He or she might will likely
perform a physical exam and might use screening tests or order some laboratory
tests to help confirm your diagnosis and ensure there isn’t another underlying
medical condition that could be driving or worsening your symptoms.
Screening Questionnaires
Guidelines from the American Psychiatric Association recommend that people
with major depressive disorder complete a rating scale—either administered by
their doctor or self-reported—to assess the type, frequency, and severity of their
symptoms. Using a rating scale to evaluate symptoms can help the mental health
professional tailor the treatment plan specifically to you.
Rating scales may include any of the following:
• Patient health questionnaire (PHQ 9): This self-test can help

diagnose depression and then evaluate the severity.
• Quick inventory for depressive symptomatology self-report

(QIDS SR): This is a 16-item self-test that is translated into multiple
languages (www.ids-qids.org). It is used to assess a broad range of

depression symptoms, and it can be used to track treatment response.
• Beck depression inventory (BDI): This classic depression self-test

contains 21 questions that assess the intensity of depression.
• Center for epidemiologic studies-depression scale (CES-D): On

this depression test, you will be asked to check off which of 20 statements
you have felt in the past one to seven days.
• Hamilton rating scale for depression (HRSD)/Hamilton

depression rating scale (HDRS) or HAM-D: A psychologist or
psychiatrist administers this 21-question scale to assess the severity of
depression in people who already have been diagnosed.
• Zung self-rating depression scale: The user checks off how often he
or she has experienced certain symptoms.
Laboratory tests
The following blood tests can help detect medical conditions that can cause
depression symptoms:
• Levels of hormones, such as thyroid hormone
• Infection, such as Lyme disease or HIV
• Levels of medications or illicit drugs
• Blood sugar (glucose) levels
• Liver and kidney function tests
• Complete blood count (CBC)
• Levels of vitamins and minerals such as B12, folate, calcium, and

vitamin D
• Test for inflammatory problems, such as erythrocyte sedimentation rate

(ESR)
Less commonly, people with depression symptoms may be given brain scans,
cardiovascular testing, neuropsychological testing, or a sleep study to rule out
diseases that mimic or contribute to depression.
VI. Depression Treatments: Therapy

There are many options for treating depression, from antidepressants to
psychotherapy (talk therapy) and even pioneering brain and nerve stimulation
treatments. Yet there isn’t a single “one-size-fits-all” treatment. To find the
treatment that will work best for your type and severity of depression, you’ll need
to work closely with your doctor.
In this chapter, we take a look at therapy options, followed in Chapter VII. by

medications and natural depression remedies.
Specialists Who Treat Depression

Your family doctor is the first person you should approach about your symptoms
of depression and, in many cases, will be able to provide some, if not all of your
treatment. Many people with depression, however, require the help of a
professional who specializes in mental illness. Such professionals include:
Psychiatrist
These physicians (MDs) specialize in the prevention, treatment, and diagnosis of
mental disorders. Psychiatrists are able to prescribe medications for depression.
They also may treat patients with talk therapy or refer patients to psychologists,
social workers, or other mental health professionals for talk therapy. They must
be licensed to practice in the state in which they work. Psychiatrists also may be
certified by the American Board of Psychiatry and Neurology.
Psychologist
These specialists typically hold a doctorate degree (PhD, PsyD, or EdD) or
master’s degree in psychology. Psychologists can diagnose depression using
various tests, and they can treat the condition with talk therapy. In most states,
they cannot prescribe drugs but often refer patients who need depression
medication to psychiatrists, primary care doctors, or nurse practitioners.
Psychologists must be licensed by their state and certified by the American Board
of Professional Psychology.
Psychiatric nurse
Psychiatric nurses are specialized nurses who treat people with depression and
other mental health issues. They hold a degree in nursing, are licensed as
registered nurses (RN), and have additional training in psychiatry. In some
states, psychiatric nurses can prescribe medications, but usually only under a
doctor’s supervision.
Social worker
Social workers hold a master’s degree in social work and are trained in
psychotherapy. Most states require them to be licensed or certified. Clinical social
workers often work for hospitals or social services agencies. They help ensure
that patients get access to the care they need. Like psychologists, social workers
work closely with a psychiatrist, primary care doctor or nurse practitioner if
patients need depression medication along with talk therapy to treat their
depression.
Therapist
“Therapist” is a broad and non-specific term for professionals who provide
support to families, groups, or individuals. Therapists may have some form of
certification and licensure. Many but not all therapists are social workers,
psychologists, or psychiatrists. However, there are therapists (such as certain
mental health or addiction counselors) who do not have a master’s, doctorate, or
MD degree but have completed shorter, specialized training programs. If you
choose to see a therapist, it’s a good idea to ask about their training and
experience in treating depression.
Choosing the Right Mental Health Professional

Here are some tips for finding the psychiatrist, psychologist, or other mental
health professional who best fits your needs:
• Referrals: Ask your primary care physician for a referral. The American
Psychological Association or American Psychiatric Association both offer
online listings of psychologists and psychiatrists in your area.
• Local hospitals: Many hospitals and health centers have departments of

psychiatry or divisions of mental health that can offer information on local
resources. Increasingly, hospitals have their own specialized depression
treatment and research centers.
• Health insurance: Contact your insurance company for information

about local providers with expertise in depression.
• Area of expertise: Ask about the mental health professional’s areas of

expertise (including types of mental health problems treated and kinds of
treatment offered), professional degrees held, and number of years in
practice.
• Personality and style: When you meet with the mental health
professional for the first time, make sure you are comfortable with his or
her personality and style.
• Treatment recommendation: After you have your first session, ask

what treatment or range of treatments your clinician recommends and
how long treatment will take. It’s also a good idea to ask how long it will
take to start feeling better once treatment has begun.
Types of Depression Therapy

Another important component of treatment for depression is to talk with a
trained professional about the issues that may be causing or worsening your
symptoms. It might sound simple, but talking can lift a lot of the emotional
weight that you feel. Psychotherapy is available in one-on-one sessions, as part of
a group, or in conjunction with your spouse or family.
Cognitive Behavioral Therapy (CBT)

People with depression are often plagued by negative thoughts. The idea behind
CBT is that your thoughts can have a big impact on your mood. This treatment
aims to identify and then change your negative perceptions to give you a more
positive outlook. CBT starts with identifying the negative thoughts you have
about yourself (“I’m a failure”), your environment (“Everyone hates me”), and
your future (“I have nothing to look forward to”). Working closely with your
therapist, you start to understand how certain negative beliefs have no basis in
reality. Then, you reframe those false beliefs and replace them with more positive
ones.
Acceptance and Commitment Therapy (ACT)

The primary goal of ACT therapy is to help individuals accept what is out of their
personal control and to commit to actions that can improve and enrich their lives.
Taking a somewhat different perspective about thoughts and feelings than CBT,
ACT adopts the view that trying to change them can be counterproductive. A
therapist using an ACT approach often uses mindfulness techniques, which teach
recognition and acceptance of thoughts and feelings without judgment and
without any attempt to change them. In doing so, negative thoughts and feelings
can have less of an influence on one’s actions and wellbeing. Another component
of ACT is to learn to focus on values and activities that bring meaning to one’s
life.
Concreteness training (CNT)

This intriguing new form of psychotherapy, which uses many of the principles of
CBT, is known as concreteness training, or CNT. The therapy involves teaching
depressed people, who have a tendency toward negative abstract thinking and
overgeneralization of negative thoughts, to think more concretely. For instance,
the therapy involves teaching people to be more specific when thinking about
individual problems, with the goal of keeping their problems in perspective and
working on concrete solutions, rather than just worrying about them.
Interpersonal therapy (IPT)

Interpersonal therapy focuses on identifying the relationship issues that are
driving your depression symptoms, particularly unresolved grief, relationship
conflicts, transitions to a new role (such as from wife to wife and mother), and
difficulty with interpersonal relationships. Then it helps you improve your
communication and conflict resolution skills so that you are better equipped to
handle issues that arise with your friends and family members.
Psychodynamic therapy
Psychodynamic therapy is often a longer-term approach to treating depression.
This treatment seeks to identify the roots of your depression by focusing on the
behaviors and relationships that are making you unhappy and then developing
new insights about how they affect you. You may go back as far as your early
childhood, recalling events that you might have consciously forgotten but that are
unconsciously driving your dark mood. By using techniques such as self-
reflection and self-examination, your therapist can bring the painful memories
and feelings that are haunting you to light and then try to work through them so
you can learn how to live a healthier, happier life.
Dialectical behavior therapy (DBT)

DBT was primarily developed for people who struggle with a particularly severe
form of personality disorder called borderline personality disorder, which
includes profound feelings of emptiness, unstable interpersonal relationships,
self-destructive behaviors, and suicidal tendencies. DBT emphasizes acceptance
and change, and was influenced by psychological research and practice as well as
by Buddhism.
Brain and nerve stimulation therapies

No one is exactly sure why, but it appears that stimulating the whole brain,
certain parts of the brain, or specific major nerves can sometimes produce relief
from depression, even when other therapies fail. Different brain and nerve
stimulation therapies vary with respect to the area being stimulated, the source of
the stimulation, and the invasiveness of the procedure, but in all cases the goal is
to get brain cells firing, new connections forming, or communication networks
re-balanced.
Electroconvulsive therapy (ECT)

ECT is a safe and highly effective medical therapy used to treat severe depression
that has not responded enough to medication and psychotherapy. ECT uses an
electrical shock to trigger seizures in the brain, but the current is well controlled
and delivered while the patient is under anesthesia, making it painless. It’s
designed to cause the brain to release the neurotransmitters that improve mood.
Deep brain stimulation

A more invasive technique, called deep brain stimulation (DBS), involves
implanting a device in the chest. The device sends electrical signals directly into
specific brain regions via wires connected to electrodes implanted deep in the
brain. These signals stimulate areas in the brain that affect mood and depression.
Transcranial magnetic stimulation

This noninvasive therapy uses an electromagnetic coil placed on the forehead to
send pulses to a part of the brain that helps regulate mood. Unlike more invasive
brain stimulation techniques, TMS can be delivered right in a doctor’s office
using specialized equipment.
A more recent version of TMS is called deep TMS because it involves stimulation
of deeper regions of the brain than TMS. Deep TMS may prove to be more
effective for some individuals than regular TMS, but further information is
needed about this innovative form of treatment.
Transcranial direct current stimulation

An even newer brain stimulation technique is called transcranial direct current
stimulation (tDCS). Also noninvasive, this technique involves using electrodes
placed on the scalp to run a weak electrical current into the front portion of the
brain, which is the area responsible for intellectual functioning.
Magnetic seizure therapy (MST)

Already available in a handful of medical centers worldwide, MST provokes
seizures in the brain in a manner similar to ECT. The difference is that instead of
using electrical currents to stimulate generalized seizures, MST employs
magnetic pulses to induce seizures in only one small portion of the brain. The
biggest benefit of this more focused treatment is that it is less likely to produce
the memory problems commonly seen with ECT.
Nerve stimulation therapies

Electrical and magnetic stimulation as a means of relieving depression is not just
limited to the brain. Other forms of stimulation target major nerve pathways.
In vagus nerve stimulation (VNS), a pacemaker-like device called a pulse

generator (about the size of a silver dollar) is implanted in the chest by a surgeon
(usually a neurosurgeon or thoracic surgeon). The pulse generator sends signals
to the vagus nerve in the neck for about 30 seconds once every five minutes.
These signals are thought to improve mood, although doctors still don’t know
exactly how.
A new and experimental electrical stimulation therapy that is showing promise

for treating depression is called trigeminal nerve stimulation (TNS). This
therapy was originally designed for patients with treatment-resistant epilepsy.
TNS uses a stimulator about the size of a large cell phone, which is connected by
wires to electrodes attached to the forehead. The electrodes send an electrical
current to the trigeminal nerve in the face. Stimulating this nerve sends signals
deep into the brain in a noninvasive way.
Complementary and Alternative Therapies

Some people prefer to try alternative therapies for depression. Although some of
these treatments have shown effectiveness against depression symptoms, they
may not be enough to fully treat all aspects of the condition, particularly if you
have more severe depression.
It’s important to check with your doctor before taking any therapy—even a
natural remedy—to make sure you are receiving the best and safest treatment
possible. It’s also important to be sure that natural or alternative remedies you
are taking or would like to take do not interact with any drugs you are taking for
depression or another medical condition. Both your doctor and your pharmacist
can help you determine that.
VII. Depression Treatments:

Medications and Natural Remedies
For anyone struggling with depression, there may be medications and natural
approaches that can help. In this chapter, we’ll discuss commonly prescribed
antidepressants and meds as well as natural strategies that can ease symptoms.
Depression Medications
Medications that are most often used to treat depression are thought to improve
mood by adjusting levels of the brain chemicals (neurotransmitters) that
contribute to feelings of depression.
Antidepressants
Antidepressants are usually the first drugs prescribed for depression. Because the
different types of antidepressant drugs have similar effectiveness, which
medication your doctor prescribes will largely depend on the side effects and how
well you tolerate the drug.
Selective serotonin reuptake inhibitors (SSRIs)

Among the newer antidepressant classes, SSRIs are widely considered to be the
first choice for patients who receive antidepressants. They include fluoxetine
(Prozac), citalopram (Celexa), sertraline (Zoloft), escitalopram (Lexapro), and

paroxetine (Paxil). Potential side effects include increased risk of sunburn, rash,
drowsiness, kidney or liver impairment, and low blood sugar and low blood
sodium levels.
Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Another relatively new class of antidepressant that may be just as effective as the
SSRIs. Examples include duloxetine (Cymbalta), venlafaxine (Effexor), and
desvenlafaxine (Pristiq). Most common side effects: excessive sweating, dry
mouth, nausea, and dizziness.
SNRIs also may cause tiredness, difficulty urinating, constipation, or sexual

problems such as reduced desire, difficulty reaching orgasm, or erectile
dysfunction.
Reuptake inhibitors and receptor blockers

Two drugs in this class are FDA-approved to treat depression: trazodone
(Desyrel) and nefazodone (Serzone). Nefazodone is rarely prescribed today
because of its association with rare but serious liver problems. Dizziness,
nervousness, nausea, drowsiness, and headaches are among the potential side
effects, as are diarrhea, vomiting, dry mouth, and reduced sexual desire.
More antidepressant medications

Newer antidepressants that work a little differently from those listed above
include:
• Bupropion (Wellbutrin), which has as more common side effects

anxiety, hyperventilation or shortness of breath, dry mouth, irritability,
shaking, restlessness or sleeplessness, or irregular heartbeats;
• Mirtazapine (Remeron), which can produce as more common side

effects dizziness, drowsiness, back pain, increased appetite, weight gain,
and constipation and as less common side effects back pain, abdominal
pain, low blood pressure, vomiting, trembling or shaking, thirstiness, and
n increased need to urinate.
• Vilazodone (Viibryd), which may result in diarrhea, dizziness, dry

mouth, nauseous feelings, and sleeplessness.
• Vortioxetine (Brintellix), which can cause such side effects as

constipation or dry mouth (more common) or excessive gas, itchy skin, or
unusual dreams (less common).
Older antidepressants
Tricyclic antidepressants (TCAs)

Among the oldest antidepressants, this class includes imipramine (Tofranil),
nortriptyline (Pamelor), desipramine (Norpramin), amitriptyline (Elavil), and
clomipramine (Anafranil). Side effects can range from dry mouth to increased
sweating, increased appetite to urinary retention, and blurred vision to
drowsiness.
Monoamine oxidase inhibitors (MAOIs)

Also an older class of drugs and generally reserved for very treatment-resistant
depression because of their multiple interactions with food and other drugs,
MAOIs include tranylcypromine (Parnate), phenelzine (Nardil), isocarboxazid
(Marplan), and selegiline (Emsam, which comes in a skin patch formulation).
Most common side effects include insomnia,headaches, dizziness, drowsiness,
dry mouth, or nausea.
Other medications
Other drugs are sometimes prescribed in people with depression include anti-
anxiety medications (also known as anxiolytics) such as lorazepam (Ativan) or
clonazepam (Klonopin) to treat accompanying anxiety; atypical antipsychotics
such as aripiprazole (Abilify), quetiapine (Seroquel), or olanzapine (Zyprexa), to
boost the effects of antidepressants; and mood stabilizers such as lithium and
anticonvulsants to manage bipolar disorder.
8 Serotonin Deficiency Symptoms You Can

Identify Yourself
Serotonin is a powerful brain chemical that profoundly affects your mood—an
inhibitory neurotransmitter that serves to balance any excessive excitatory
(stimulating) neurotransmitters (like dopamine) that may be firing in the brain.
With adequate serotonin levels in the brain and its proper functioning, you’ll be
positive, happy, confident, flexible, and easygoing. With low levels of serotonin,
you’ll begin to display serotonin deficiency symptoms by becoming negative,
obsessive, worried, irritable, sleepless, or depressed.
Finding out whether you're serotonin-deficient is a key step in eliminating mood

and impulse-control problems. Julia Ross, author of The Mood Cure, has an
excellent mood type self-exam that can help you determine whether you have a
serotonin or a dopamine (norepinephrine) deficiency. Below are some of the
primary ways, per Ross’s test, to determine whether you have serotonin
deficiency symptoms.
1. Is your depression negative in nature? That is, are your thoughts

frequently pessimistic, gloomy, distrustful, and cynical?
2. Are you a woman? Women have depression more often than men and when
they do, serotonin deficiency is more often a factor than in men. On the other
hand, when men become depressed, they seem to more often have dopamine
deficiencies where their depression is expressed as apathy or lack of interest or
lack of an ability to focus. This doesn’t mean that men can’t have serotonin
deficiency and women can’t have dopamine deficiency—they can—but the general
tendency is the other way around. A study published in September 2007 in the
journal Biological Psychiatry showed that men and women react to serotonin
deficiency in different ways. Men became impulsive but not necessarily
depressed. Women, on the other hand, experienced a marked drop in mood and
became much more cautious, an emotional response commonly associated with
depression. The researchers concluded that this may be why more women than
men experience anxiety and mood disorders, while more men experience
alcoholism, ADHD, and impulse control disorders.
3. Do you crave sweets and starches? These are foods like breads and
potato chips and any sugar-laden food. These foods temporarily raise serotonin
levels and make you feel better so your body craves them. In the long run though
they actually deplete serotonin levels and cause significant weight gain.
4. Do you have significant insomnia issues? Serotonin deficiency

symptoms include waking up in the middle of the night and not being able to go
back to sleep and having to sleep in many different positions in order to feel
comfortable.
5. Do you have feelings of low self-esteem? That is, you’ve lost your
confidence and sense of self worth. You easily become critical of yourself or feel
guilty about something you’re doing or not doing.
6. Do you often feel worried or apprehensive or have panic attacks?

False fear is a telltale sign of serotonin deficiency which can manifest itself as
phobia, worry or even excessive shyness.
7. Do you sometimes exhibit aggressive or violent behavior even

including thoughts of suicide? Studies show that serotonin deficiency in the
brain is associated with an increased susceptibility to impulsive behavior,
aggression, overeating, alcohol abuse, and violent suicide.
8. Have you had any of the following disorders: fibromyalgia

(unexplained muscle pain), temporomandibular joint disorders, or TMJ (pain,
tension, and grinding associated with your jaw), migraines, irritable bowel
syndrome, obesity, or asthma? Each condition has low serotonin levels
implicated as an associated cause; studies show that raising serotonin levels
improves the severity.
Restoring serotonin levels in the brain are critical but doable steps in recovering
from any of these conditions. Fortunately, the body’s store of serotonin can be
restored back to healthy levels through a natural health protocol involving the use
of a specific amino acid supplement.
Maintenance drug therapy

Depression treatment guidelines from the American Psychiatric Association
recommend that doctors use maintenance drug therapy to prevent depression
from returning. This is especially important for people whose depression tends to
recur, and particularly for those who have had three or more episodes of
depression or have a chronic illness. This means that your doctor may
recommend staying on your medication even after you are feeling better.
In some cases, you may try lowering your dose, especially if you’re experiencing
troublesome side effects, but only with the help of careful follow-up from your
doctor. You should never stop taking medication prescribed for depression on
your own. Your symptoms could recur or you might experience uncomfortable
effects associated with rapid withdrawal of the medication.
Natural Therapies for Beating Depression
Diet
What you eat can have a big impact on your mood. Foods like fish, nuts, and
seeds, which are high in omega-3 fatty acids, may help ward off depression. That
might be why people who eat a Mediterranean diet (in which olive oil, nuts, and
fish are staples) are less likely to develop depression than people who eat other
kinds of foods. Processed and sugary foods are high in simple carbs and trans
fats, which may boost energy transiently, but ultimately can drain your energy
and make you feel even more down in the dumps.
Vitamins and supplements

• Omega-3 fatty acid supplements: The essential polyunsaturated fatty
acids found in fish like salmon, tuna, and halibut, as well as in flaxseed
and other plants, are crucial to healthy brain function. A number of studies
have found that people with diets that are high in fish are less likely to be
depressed, but results of studies on the effectiveness of omega-3 fatty acid
supplements for treating depression have been mixed.
• B and D vitamins: There is some evidence linking deficient levels of

certain B vitamins and vitamin D with depression. B vitamins are
important for the production of brain chemicals that help regulate mood,
and vitamin D is important for proper communication between the
nervous system and the rest of the body. At least in older people,
researchers have found that higher intake of some B vitamins may help
prevent depression. Recently, vitamin D supplementation among women
with known vitamin D deficiency has been shown to be an effective

treatment for depression, but it is less clear whether vitamin D is helpful
for alleviating mood problems when vitamin D deficiency is not present.
• S-adenosylmethionine (SAMe): pronounced “sammy”, this natural

substance is found in all of the body’s cells. It helps produce serotonin and
dopamine, and it participates in myriad other natural physiological
reactions in the body. Taking SAMe in supplement form is thought to
increase the levels of certain brain chemicals and improve mood.
• St. John’s wort: This flower extract is one of the most popular, and best
studied, alternative remedies for depression. Although a large review of
studies conducted by the National Center for Complementary and
Alternative Medicine (NCCAM) showed that the herb wasn’t any better for
treating major depression than a placebo, it may be more effective for
mild-to-moderate depression. But be careful, as this herb has side effects
and can interact with many different types of drugs.
• Roseroot: This is another herb that has been shown to help alleviate
symptoms of depression. Used for over 3,000 years in European folk
medicine, a new study suggests roseroot might be nearly as effective as an
antidepressant but without the troublesome side effects.
Depression-Busters: 4 Dopamine Boosters

Dopamine normally gets triggered when you approach and expect a reward.
With the release of dopamine in the brain comes a good feeling and a surge of
energy so you can reach your reward. Dopamine motivates you to seek, alerts
your attention to things that meet your needs, and motivates you to persist in
your pursuit of those things that meet your needs. Without enough dopamine,
your motivation goes kaput and you’re unable to experience pleasure from
activities usually found enjoyable, e.g. exercise, hobbies, music, sexual

activities, or social interactions. In other words, dopamine deficiency causes a
bad case of the “blahs.” The four supplements presented here—L-Tyrosine,
Rhodiola, Mucuna, and L-theanine—have been found in studies to increase
dopamine and/or help balance dopamine function in the brain.
1. L-Tyrosine. The conditionally essential amino acid tyrosine is a

precursor of catecholamine neurotransmitters, including dopamine. It can
be taken through diet (especially from meat, eggs, and fish) or synthesized
in the body. Tyrosine forms DOPA, which is then converted to dopamine,
and this, in turn, forms norepinephrine, another neurotransmitter related
to mood.
By supporting production of neurotransmitters like dopamine, L-tyrosine

supplements can enhance mood, sleep, emotional well-being, and
cognitive/mental function, especially under situations involving
environmental and emotional stress or when dopamine levels require
additional support (some people are genetically programmed to make too
little dopamine). Start by taking one 500 mg capsule of L-tyrosine. If you
feel no benefits within 30 minutes, take a second capsule, and a third in
another 30 minutes if you still feel nothing. Continue by taking one to
three 500 mg capsules two or three times a day: early morning, mid-
morning, and mid-afternoon. Decrease the dose if you feel agitated or your
blood pressure increases.
2. Mucuna: Commonly known as velvet bean, mucuna pruriens naturally

contains up to 5 percent L-Dopa (levodopa). L-DOPA is the same
biochemical that is made in humans from the amino acid L-tyrosine and is
then synthesized into dopamine. When taken as a supplement, the L-
DOPA from Mucuna can cross the blood-brain barrier to elevate brain
dopamine levels.
Powdered mucuna seeds have long been used in Indian traditional

medicine as support in the treatment of various illnesses, including
Parkinson’s. Recently, studies utilizing Mucuna supplements have shown
promising results not just for Parkinson’s but for other conditions related
to dopamine deficiency, including depression and psychological stress.
Mucuna extract has been shown to increase not only dopamine
concentrations, but also other neurotransmitters that affect mood, such as
serotonin and norepinephrine. Look for an extract of Mucuna pruriens
standardized to contain 15 percent L-DOPA. Take 300 mg twice a day.
3. L-theanine. This amino acid, uniquely found in green tea, creates an

alert state of relaxation without drowsiness. L-theanine is known to be
able to cross the blood-brain barrier and increase dopamine levels in the
brain. Animal studies show that L-theanine also increases brain serotonin
and GABA. It has antidepressant and anti-anxiety effects, reduces mental
and physical stress, and leads to improvements in learning and memory in
humans and animals. Even just a single, small dose of L-theanine (100
mg) significantly improves the ability to pay attention and maintain focus
compared to placebo. Take 200 mg of L-theanine two to three times daily.
4. Rhodiola. A popular plant in traditional medicine in Eastern Europe

and Asia, rhodiola rosea, or “golden root,” has a reputation for improving
depression, enhancing work performance, eliminating fatigue, and
treating symptoms resulting from intense physical and psychological
stress. Rhodiola exerts its benefits via multiple effects on the central
nervous system, including enhancing the stability of dopamine and
supporting its reuptake. This leads to notable decreases in depression,
anxiety, and fatigue as well as an increased ability to handle stress.
In human studies, rhodiola has been shown to significantly reduce

depression, anxiety, and stress-related fatigue compared to placebo. Look
for a rhodiola extract derived from rhodiola rosea root and standardized to
contain 3 percent total rosavins and a minimum 1 percent salidrosides.

Take 170 mg twice a day.
Don't Forget Multivitamins

Certain minerals and B-vitamins, especially zinc, vitamin B6, and folate, are
necessary for dopamine synthesis and neurotransmission. These nutrients are
often depleted in individuals due to medications, inadequate diets, excessive
stress, and toxic environmental exposures, compromising the ability to
properly synthesize neurotransmitters like dopamine.
Potential Side Effects, Precautions, and Drug Interactions

Of course, too much dopamine is dangerous and needs to be avoided. Do not
take more than one dopamine supplement at a time without first consulting
with a healthcare practitioner, preferable one trained in integrative or natural
medicine.
Similarly, do not use these supplements if you are taking methyldopa,

antidepressants, or antipsychotic drugs without first consulting with a
physician. Tyrosine and Mucuna pruriens may also interact with some
nutritional supplements, including St. John's Wort, 5-HTP, Tryptophan, and
SAMe. Therefore, you should also consult your healthcare practitioner before
combining these supplements. Do not take these supplements if you are a
pregnant or lactating woman.
Exercise
Research reveals that what’s good for the body is also good for the mind. When
you go for a run or a swim, your brain releases brain chemicals such as
norepinephrine and endorphins—both of which can boost mood.
Massage
If you have ever had a massage, you know how relaxed the therapy can make you
feel. A review of studies found that massage therapy had “potentially significant
effects” on the symptoms of depression, possibly through its ability to reduce
stress and induce a state of relaxation.
Acupuncture
This traditional Chinese medicine practice of stimulating various pressure points
throughout the body with very fine needles has been used to treat conditions
ranging from osteoarthritis to low back pain. Although one review of studies did
not find enough evidence to recommend the use of acupuncture for depression,
another study found that acupuncture significantly improved depression in
pregnant women.
Relaxation techniques
Guided imagery, in which you use a recording or the help of an instructor to focus
on a particular image (such as a lemon) in great detail, can be a good way to teach
your body how to relax. Meditation, in which you sit quietly for 10 to 15 minutes
and repeat a word or “mantra,” is another effective relaxation technique. Yoga
also can help relax the body and mind. Recently, mindfulness meditation, a form
of meditation adapted from Buddhist practice in which you learn to be in the
moment and accepting of your immediate thoughts, feelings, and sensations in a

non-judgmental manner, has been shown to be particularly effective for mental
health issues.
Light therapy
In people with seasonal affective disorder (SAD), short, dark winter days trigger
depression. It is thought these symptoms are caused by alterations in the body’s
circadian rhythm and production of melatonin (a hormone that regulates sleep
and mood). “Light therapy” can help regulate circadian rhythms and melatonin
production to boost mood, not only in people with SAD but also in those with
depression who want to try an alternative to medication and therapy.
8 Natural Dopamine Boosters to Overcome

Depression
Depression is a disease caused in many cases by actual physiologic changes in
your brain. Therefore,when you feel depressed, don’t think of it as a defect in
your personality; rather, think of depression as you would any other illness.
If you have a broken bone, you need to wear a cast to stabilize the bone while it
heals. If you have depression, you need to address the underlying "root problem”
in your brain—one of which might be a deficiency of dopamine, the brain
chemical (neurotransmitter) that allows us to have feelings of bliss, pleasure,
euphoria, drive, motivation, focus, and concentration.
When there is too little dopamine, emotions cannot be correctly regulated.

Mental impulses that mitigate intense feelings of sadness are inhibited; therefore,
the most common signs of a dopamine deficiency are the same signs associated
with clinical depression (and, more specifically, major depressive disorder).
The good news is that you can use natural remedies to increase dopamine levels
in your brain. Below are eight strategies:
1. Decrease your sugar intake. Sugar alters brain chemistry by disrupting

dopamine levels, which is one reason why people often experience a “sugar high”
shortly after eating sweets. Just as alcohol and drugs can deplete dopamine
levels, sugar does the same. In fact, sugar stimulates the exact same euphoric
pathway targeted by alcohol and drug use--that is, the decreased dopamine levels
lead to actual sugar addictions. If you struggle with a sweet tooth, you can take
chromium picolinate supplements to help decrease your sugar cravings.
2. Take tyrosine. When your brain cells need to “manufacture”

neurotransmitters for proper mood regulation, they use amino acids as the
essential raw material. Amino acids are the building blocks of protein; there are
20 different amino acids that make up the protein our body needs. The brain uses
the amino acid l-phenylalanine as the source (precursor) for the production of
dopamine. Phenylalanine is one of the “essential” amino acids; that is, the body
cannot make it on its own so we have to get it from the foods we eat or from
supplements. Once the body receives phenylalanine, it can convert it to tyrosine,
which in turn is used to synthesize dopamine.
So the way to increase central nervous system neurotransmitter levels is to

provide proper amounts of the amino acid precursor. Bananas, especially ripe
bananas, are an exceptional food for regulating dopamine because they have a
high concentration of tyrosine. Other food sources of tyrosine: almonds, apples,
watermelons, cherries, yogurt, beans, eggs, and meats.
3. Decrease caffeine intake. Even though coffee gives you the energy boost
you need, just like sugar, it only offers temporary relief and may actually be doing
more harm than good. After experiencing the initial kick caffeine offers,
dopamine levels in the body decrease. So, go for a cup of decaf or at least
minimize consumption of coffee to counter dopamine deficiency.
4. Set a routine schedule. One easy way to boost dopamine is to get in a

healthy routine and stick to it. Your routine should include adequate time for
work and rest. Ideally, your 24-hour day should include seven to eight hours of
sleep per night in combination with periods of physical activity. Under-sleeping
and/or over-sleeping combined with lack of regular exercise can drain the brain
of dopamine.
5. Get consistent exercise. Regular physical activity increases blood

circulation to influence the presence of many different hormones within the
brain, affecting dopamine levels.
6. Decrease stress levels. High stress levels are also strongly correlated with
dopamine deficiency. Stress can be caused by two sources: poor adrenal function
and chronic daily life stressors. While we can’t always control our circumstances,
there are “stress safeguards” you can utilize to help you deal with the day-in and
day-out anxieties.
7. Correct a magnesium deficiency. Magnesium deficiency can cause

decreased levels of dopamine, and natural health experts estimate that more than
half of the U.S. population to be deficient in this relaxation mineral. If you’ve
been eating a diet heavy in junk foods or processed foods, you probably have a
magnesium deficiency. Common symptoms include food cravings (salt or carbs),
constipation, high blood pressure, rapid heartbeat or palpitations, muscle pains
and spasms, fatigue, headaches, and such depression symptoms as mood swings,
anxiety, and irritability.
8. Take vitamins for depression. Dopamine is easily oxidized. So, the

antioxidants contained in vitamins (such as C and E) protect the health of brain
neurons that use dopamine.
New and Experimental Treatments for

Depression
Researchers are constantly working to fine-tune and add to the currently
available therapies for depression. Here are a few of the exciting new
developments you might expect to see in the near future:
• Agomelatine (Valdoxan): Agomelatine works on two types of brain cell

receptors: a type of serotonin receptor called 5HT2C and a receptor for the
sleep-regulating hormone melatonin. Research suggests it might be
particularly beneficial for the treatment of anxiety related to depression.
• Triple reuptake inhibitors: Researchers are working on a number of

antidepressants that block the reuptake of three neurotransmitters:
serotonin, norepinephrine, and dopamine. They hope that by making
more of all three of these chemicals available in the brain, triple reuptake
inhibitors will have a more significant impact on depression than the
antidepressants that are currently available (which generally work on only
one or two neurotransmitters).
• Stress hormone blocking agents: Certain hormones released during

the “fight-or-flight” stress response (such as cortisol) may have a role in
depression, particularly in forms of depression that develop from chronic
stress. Medications such as mifepristone (Mifeprex), which block cortisol
production, are currently being investigated for the treatment of
depression.
• Neurogenesis stimulators: There are a number of experimental

therapies undergoing study for the treatment of depression each of which,
in their own different way, stimulate neurogenesis, or the growth of new
nerve cells and connections within the brain. They include glutamate
blocking drugs such as ketamine and similar drugs, which are being
actively researched for use in depression.
• Brain-derived neurotrophic factor stimulators: It is now believed

that many antidepressants boost the levels or activity of chemicals in the
brain that promote nerve health and growth, such as brain-derived
neurotrophic factor (BDNF). Some researchers believe that
antidepressants may reduce the risk of brain atrophy (shrinkage) in
patients with chronic depression because they can promote BDNF.
Although BDNF cannot be given as pills, the observation that
antidepressants may have an effect on BDNF has opened new avenues for
treatments that replicate this action on the brain.
When Depression Treatments Don’t Work

Your doctor will work closely with you to find the best treatment, whether it is
medication, psychotherapy, or a combination of therapies. But depression can be
a tough target to nail. You might have to experiment with several different
treatments before you find the one that works best for you. Your doctor may need
to adjust your antidepressant dose, switch you to a new medication, combine
medications or psychotherapies, or add a technique like brain stimulation if
medication and therapy aren’t enough. You can also discuss alternative and
integrative therapies for depression, such as exercise or acupuncture.
Treatment-resistant depression
If it seems as though you’ve tried every medicine and therapy and your
depression still refuses to go away, you might have treatment-resistant
depression, which is the term used for depression that hasn’t responded to
several different antidepressants or psychotherapy. This doesn’t mean that you’ll
never find a treatment that works, or that you’ll be forced to endure depression
for the rest of your life. It just means that you and your doctor will have to try a
few different approaches to relieve your depression.
Know that there will be a therapy out there that will eventually work for you.
Don’t give up. Recent research has shown that most people who are depressed
need to try several therapies—or combinations of therapies—before they find the
regimen that works for them.
In other words, it’s quite normal not to feel better right away, but most people
who persevere eventually find a treatment that works. Moreover, people who do
find the treatment that works well for them are less likely to have a relapse of
their depression in the future.
VIII. Living with Depression

Depression can quickly turn into a self-perpetuating cycle. You feel awful, so you
refuse to do anything you once thought was fun; you may not even venture out to
see your friends. Your inactivity and isolation in turn feed your depression.
The key to overcoming depression and moving into the light is to break that cycle.
© Monkey Business Images | Dreamstime.com

Depression is best served by finding support, whether it’s via friends, a support group, or a
therapist.
Finding Support
Getting help for your depression starts with a visit to your doctor or a mental
health professional for diagnosis and treatment. Once treatment is under way,
seek out the type of support that works for you, whether it is:
• Talking to a friend or family member
• Meeting with a therapist or counselor for personal, marriage, family, or

group therapy
• Joining a support group of people with depression
• Visiting an online support group
• Talking to a trusted member of your church, synagogue, mosque, or other

religious organization
• Joining a community group
Helping a Friend or Loved One with Depression

Despite your best intentions, helping someone with depression isn’t always easy.
Your friend or loved one might not realize he or she is depressed or may not be
willing to accept your help. Realize that you cannot “cure” that person, no matter
how hard you try. All you can do is help someone recognize that there is a
problem, let him or her know you care, and suggest professional help.
When you first approach your friend or loved one about depression, bring with
you a few recommendations for available local services, such as the names and
phone numbers of therapists or support groups. Gently keep track of whether
your loved one seeks treatment and takes medication as prescribed. Offer your
encouragement along the way. Be on the lookout for signs of suicidal tendencies.
If you see any warning signs, call a mental health professional or 911 right away.
Don’t shy away from asking someone directly about depression. Even trained
professionals sometimes don’t recognize the signs and symptoms in themselves.
Feedback from a concerned friend or family member is often a helpful “wake-up
call,” whether or not that friend or family member decides to act on it right away.
Similarly, don’t hesitate to ask whether a close friend or family member has had
any thoughts of self-harm or not wanting to live. Asking about suicide does not
make it more likely. On the contrary, it allows a loved one to share the burden
and get the help he or she needs. Suicidal thoughts are often part of being
depressed. They do not necessarily require hospitalization, but they do need to be
taken seriously, and they always require urgent evaluation.
Preventing Episodes of Depression

You can lessen the blow of depression by recognizing when you have symptoms
and getting professional help. Follow the treatment plan your doctor prescribes.
Contact your doctor right away if you are having bothersome or worrisome side
effects from your medication.
Keep in mind that some side effects get better on their own within the first few
days or weeks of starting a medication, while others require a change in dose or
medication. Don’t change any part of your treatment without first talking to your
doctor. Stopping a drug suddenly can actually make side effects temporarily
worse.
Take the Long View

Keep your long-term goals in mind. It usually takes two to three weeks before you
begin to feel better, and it can take as long as six to 12 weeks to know whether a
medication will be fully effective for you. Stopping and starting medications
prematurely will not give your body enough time to respond to the recommended
treatment, and it won’t allow your doctor to determine whether the medication is
right for you. If you’re really not coping, ask your doctor to prescribe something,
such as an anti-anxiety drug, which you can take for a couple of weeks until your
antidepressant takes its full effect.
Be Kind to Yourself
Take it easy on yourself. It’s easy to blame yourself for the way you feel, or to
think that you deserve to feel the way that you do. Many people, especially men,
feel they should be able to “pull themselves together” and get on with life. You
might have even had some people tell you this. Such feelings or comments stem
from a fundamental misunderstanding of depression. Just as you can’t “decide”
one day not to have diabetes, you can’t wake up one morning and choose not to
be depressed.
What you can choose to do is get the help you need to feel better. Never forget
that no matter how bad things are, there is always something positive to hold
onto. Focus on the positive and cultivate gratefulness, which has been shown to
go hand-in-hand with good mental health.
Take Care of Yourself

Incorporate the following healthy lifestyle choices, many of which have been
shown to have a big impact on depression:
• Exercise for 30 to 60 minutes a day: When you work out, your body
releases endorphins—chemicals that make you feel better. Research has
found that exercising for 30 minutes a day can be just as effective at
relieving the symptoms of major depression as drug therapy. Exercising
will also keep your body in shape, boosting your self-esteem. Try soothing
forms of exercise, such as yoga, which recently has been linked with
improvements in the symptoms of several psychiatric disorders, including
depression, attention deficit/hyperactivity disorder (ADHD), and
schizophrenia. It may also help alleviate sleep problems, which too
frequently accompany depression.
• Maintain a healthy diet: Research shows that a healthy diet can help
ward off depression, while eating junk food can contribute to it.
• Sleep well: Depression and poor sleep are closely linked.

Understandably, people who are depressed can have trouble getting to
sleep or staying asleep because of the persistent worries that plague them.
When you don’t sleep well, you feel worse during the day. You have less
energy to go out with friends or to exercise. The link between poor sleep
and depression appears to be biological too. Some people with depression
sleep too much and never seem to feel rested. Too much or too little sleep
exacerbates the depression you’re already experiencing.
• Control stress: Stress is a big player in depression. Control it before it

controls you. Great stress-busting techniques include yoga, meditation,
progressive relaxation, and guided imagery. Whenever you feel that your
stress is getting out of control, take a step back. Take a vacation from
work, leave your kids with a babysitter, get help taking care of an ailing
spouse—whatever you need to do to regroup. Consider whether certain
obligations can be tabled temporarily.
• Put yourself in a position to experience pleasure: Even when you

doubt that you will be able to get pleasure from life because of your
depression, allow yourself to do the things you used to enjoy before your
depression took root.
• Release your emotions: When you’re feeling stressed out or sad, let it
out. Bottled-up grief and anger can ferment until it finally explodes. Talk
about your feelings to family members, friends, or a therapist. Or, write
your thoughts in a journal.
• Don’t get discouraged: Instead of punishing yourself for failing to

recover from your depression quickly, reward yourself for all the
improvements you have made. Always remember and focus on the good
times, which exist even for those in the most dire of circumstances.
Relapse Prevention
One of the most important, yet most neglected, aspects of depression treatment is
preventing depression from returning. “Relapse” refers to the return of
depression after a period of weeks or months of doing well. “Recurrence” is a
relapse that occurs late, after many months or years of stable mood and
functioning.
You need to go into treatment with the expectation that you may have periods of
improvement and periods in which your symptoms get worse. It is essential that
you discuss relapse prevention with the doctor or mental health professional who
is treating your depression.
Most important, don’t stop taking medication the minute you feel better. It can
be tempting, especially if you are plagued by uncomfortable side effects, but it can
trigger both discontinuation reactions from the drug as well as the return of your
depression. If you want to stop therapy, talk to your doctor. Some people need to
stay on medication for life while others can cope without medication, or with a
lower dose, if they maintain healthy lifestyle habits and a good support network.
Identify warning signs

For most patients, identifying the warning signs that their depression is returning
(such as becoming more isolated or not responding to emails and phone calls)
can help nip a relapse in the bud. For many people, identifying triggers of past
depression (such as a loss, move, disappointment, or work stress can also help
them develop a treatment plan with their health care provider that reduces the
likelihood of a full-blown relapse in the future.
Healthy Steps
Here are a few other healthy steps you can take to improve your health and
quality of life:
• Work to build and maintain social support
• Tackle recurrent sources of frustration in your career or home life
• Develop new hobbies
If you’re going to treat your depression successfully and keep it under control for
many years, your treatment must be part of an overall healthy lifestyle. There is
no guarantee that depression won’t come back. Even when you are doing
everything right, depression can relapse. But by doing all the right things, you are
more likely to bring your depression under control so you can get back to your
life.

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AM I

Treating depression symptoms,

A free guide published by University Health News

VIII. Living with Depression .................................................................................... 56

Common symptoms of depression

• Loss of interest in activities and hobbies you once enjoyed

• Difficulty concentrating, paying attention, and remembering

• Disrupted sleep (difficulty getting to sleep or staying asleep, or sleeping

• Change in eating habits (overeating or losing your appetite)

• Fatigue and loss of energy

• Feelings of guilt or worthlessness

• Feelings of helplessness or hopelessness

• Increased alcohol and drug use

• Neglecting your personal care (such as personal hygiene)

• Physical symptoms that don’t respond to treatment (headaches,

• Reduced sex drive

• Thoughts of death or suicide

Less common symptoms of depression

• Feeling weighed down or heavy

• Sleeping too much

Depression Test: What It Can Tell You

Do you feel sad, anxious, or “empty?”

Are you sleeping more or less than you used to?

Are you eating more or less than you used to?

Have you lost interest in activities you once

Do you feel restless or irritable?

Do you have persistent physical symptoms (such as

Do you have trouble remembering things,

Are you tired or lacking in energy?

Do you feel guilty, hopeless, or worthless?

Do you have thoughts of suicide or death?

II. What Causes Depression?

Depression and the Brain

emotion, and sleep. Dopamine affects movement, attention, and feelings of

Depression and Genes

In some cases, illnesses such as Parkinson’s disease or multiple sclerosis (MS) or

Diseases that can complicate or mimic depression

• Coronary artery disease

• Hypercalcemia (high levels of calcium in the blood)

• Hyperparathyroidism (overactive parathyroid glands)

• Hyperthyroidism (overactive thyroid glands)

• Hypothyroidism (underactive thyroid glands)

• Infection with Toxoplasma gondii (found in cat feces)

• Kidney or liver failure

• Systemic lupus erythematosus

• Vitamin deficiencies (folate, B12, D)

A number of psychological conditions also can stem from, or contribute to,

• Alcoholism and other substance abuse disorders

• Anxiety disorders—including post-traumatic stress disorder (PTSD),

• Eating disorders—including anorexia nervosa and bulimia nervosa

• Personality disorders—including borderline personality disorder

III. Depression Types

Major Depressive Disorder

Usually, there are other symptoms in addition to low mood, including:

• Appetite changes with weight loss or weight gain

• Sleeping too little or too much

• Trouble with concentration and/or memory

• Unexplained aches and pains