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Depression and Fatigue
I have never seen a patient with clinical or endogenous depression who was full of vitality. Depressed people are tired people. They are also usually anxious and perplexed people. This anxiety stems partly from a failure to identify the cause of their depression, a frequent comment being ‘I have no reason to be depressed’. Often their work, family, and lifestyle provide all they would wish for.
Depression — Mind or Body?
The symptoms of clinical depression may be well defined and recognized, but the causes of depression are the subject of controversy within the medical profession and the complementary professions.
The central point of debate that has split doctors, psychiatrists and the many other therapists who treat depression into two opposing groups, is simply the question of mind versus body.
The key issue that fuels the controversy involves the following question:
With depression does the mind affect the body or does the body affect the mind?
Many doctors believe that depression is a personality disorder and the accompanying physical symptoms that are manifested can be effectively treated with antidepressant drugs. As a result of this reasoning, I quite often see patients who have been prescribed Amitriptyline or Prozac for backache and bowel disorders.
This view is supported by the fact that many patients experience symptom-relief from their physical symptoms when taking anti-depressants. Clinical trials have confirmed that irritable bowel syndrome (IBS) and Crohn’s disease, which have long thought to be stress induced, can be improved under hypnotherapy.
However, there is overwhelming evidence to support the view that it is the body that influences the mind.
It should be realized that every thought and emotion we experience is preceded by a chemical change in the brain cells. As with all the other organs in the body, the brain only functions normally when the optimum fuel is available. We all recognize and accept that inappropriate abnormalities in our blood chemistry can alter our personality. This can be seen in alcoholism and low blood sugar as well as with the side effects of drugs and hormonal imbalances (e.g. PMS). These changes are usually transient, but the many substances that can cause depression can lead to long-term symptoms.
Depression occurs chiefly as a result of physiological, not psychological, malfunction. In common with many health problems that previously carried a psychiatric ‘label’ (such as autism, schizophrenia, attention deficit disorder and hyperactivity), depression is now seen as a nutritional or biochemical disorder.
What Happens When I Get Depressed?
The brain relays electrical messages from one nerve cell to the next with the aid of neurotransmitters. There exist around 40 of these substances whose role is to cover the space between the nerves (the synapses) so that the signals pass unimpeded.
Depression is thought by many doctors, nutritionists and researchers to be caused by a deficiency of neurotransmitters. Up until quite recently it was assumed that these vital substances occur in the brain and are not dependent on, or directly influenced by, the food we eat. The blood-brain barrier was always thought to insulate the brain from the effects of incorrect diet. We now know that neurotransmitters can be deficient, and that they can be influenced by nutritional supplements and dietary manipulation.
Examples of neurotransmitters include serotonin, dopamine, acetycholine, epinephine (adrenaline), glycine and GABA (gamma-aminobutyric acid) and the endorphins. Prescription drugs for depression influence these important chemicals.
ANTIDEPRESSANT DRUGS
The antidepressant drugs in common use fall into three separate drug groups. Each group has a different mode of action on the brain chemistry.
1 MONOAMINE OXIDASE (MAO) INHIBITORS These drugs inhibit the enzyme (MAO), that is responsible for the metabolic breakdown of the neurotransmitters, including serotonin, dopamine, epinephrine (adrenalin) and norepinephrine (noradrenaline). This allows for more of the neurotransmitters to be in circulation. The best known drugs in this group are Parnate, Nardil and Parstelin.
2 TRICYCLICS This group of drugs leads to reduction of histamine and an increase in noradrenaline. The most common of these drugs include Amitriptyline, Imipramine and Anafranil.
3 SELECTIVE SEROTONIN RE-UPTAKE INHIBITORS (SSRI’s) These work by selectively reducing the uptake of Serotonin, thus allowing more Serotonin into the circulation. The best known drug in this group is Prozac.
The Thyroid and Depression
It you suffer from low grade hypothyroidism your entire body can feel mentally and physically depressed. In fact, hypothyroidism depresses the whole metabolism. As I have mentioned (see page 10) hypothyroidism can mean that T3 is not converted efficiently from T4 at cell level. T3 (Triiodthyronine) is a powerful hormone in the body and therefore one key to understanding depression.
The T3 hormone is itself a neurotransmitter as potent in its action as serotonin. However, it is also essential to maintain the levels of serotonin and noradrenaline in the brain. If you do not have enough T3 you will be lacking in these two hormones. Noradrenaline deficiency is seen as a major cause of depression. Therefore it is vital to ascertain whether you may have low grade hypothyroidism in order to effectively treat depression.
PETER’S STORY
Peter was an international sales manager for a computer hardware company. His work was very tiring and very stressful. He had targets to set, problems to solve and planes to catch on a daily basis. Aged 50 and at the top of his promotion curve, there were several younger colleagues eager to succeed him. Being unmarried and well paid he tended to rely on restaurant meals, usually taken as working lunches and dinners. In common with many business executives he had settled into a habit of eating rich food with wine and he supported his flagging nervous system with 10-12 sweet coffees and 25-30 cigarettes daily. Not surprisingly he had been overweight for 20 years. However, his weight was not his chief concern. For the previous two years he had suffered stomach pain, heartburn, fullness after meals, fatigue, complete loss of libido, and neck and shoulder stiffness and pain.
A combination of symptoms and work pressures had contributed to his ever-worsening depression. He explained that his chief concern was whether the depression was a cause or a symptom of his ill health.
When I examined Peter he weighed 2101b. His height was six foot with medium-sized hands and feet, so I estimated that he was 351b overweight. His blood pressure was too high at 180 over 95 and he looked and sounded tired and depressed.
Although he did not complain of feeling unduly cold, I requested his morning temperatures. I also requested a full blood screen including haematology
