Are You Depressed? What Can You Do About It?

Dr Sandra Cabot and naturopath Victoria Taylor discuss the different types of depression and common symptoms that depression may present as. They discuss the medications used to manage depression, as well as the effect of diet and lifestyle factors on mental health. Learn about the different supplements that could help if you are suffering from depression.

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DR CABOT: Hello. This is Dr Sandra Cabot bringing you another podcast. And today we’re talking about depression, or feeling sad. Feeling down and not being able to get out of it. Just being stuck in depression. And I’m joined by naturopath Victoria Taylor. She’s here with me today. Hi, Victoria.

VICTORIA: Good afternoon, Dr Cabot. And hello to everybody listening.

DR CABOT: Yes. And Victoria and I have just been discussing depression because we see a lot of it. It is very common and there’s different types of depression, such as just clinical depression, which can vary from mild, moderate to severe. It could be chronic. So, it’s there for many years without a break or it can come and go. It can have bipolar tendencies, where your mood goes from feeling really high and elated and excessive to feeling really down. So that’s bipolar. It can be postpartum. So, you may have never been depressed in your whole life until you’ve had a baby and then bang! After the baby is born and the placenta is delivered, you go into a depressive illness and that is partly hormonal. Also, it could be premenstrual depression. So premenstrual mood disorder. Once again, hormonal factors are very important. And some people have atomic depression, which is very hard to treat. We call it treatment resistant depression. So, the conventional treatments of antidepressant drugs don’t work as well as one would hope.

So, you can see it’s quite complex, isn’t it?

VICTORIA: There’s just so many factors that can play into it. It’s mind boggling.

DR CABOT: Yes, there are. And the interesting thing Victoria, I’m sure you’ve seen this in your patients, is a lot of people are depressed and they don’t know they are.

VICTORIA: And it doesn’t come across all that easily. They just look a little bit shy, hesitant, sort of… a bit held back. And it’s just not easy to see the hole that they’re in.

DR CABOT: Yes, it’s true. And it’s often associated with anxiety. And indeed, anxiety makes depression worse. And in some patients, if you don’t treat the anxiety, the depression won’t get better. So that’s why they look a little bit reticent and timid.

VICTORIA: Yes.

DR CABOT: And so, it can have many forms and it can present in many ways. And one of the most common symptoms of depression is fatigue. Just being tired all the time. You wake up in the morning, you don’t want to get out of bed, you’re just tired and you may think you have a medical illness. But the doctor does all these tests, checks everything and nothing specific is picked up. So that’s a common presentation of depression. It’s just being tired all the time and lack of motivation. Feeling bad about yourself, low self-esteem, guilt, anxiety, problems with your appetite. You might go on binges, where you’re just eating a whole lot of junk food and losing control. So, you can get some really bizarre presentations of depression.

So, a lot of people will go to a doctor, which is the best thing. Go and see your GP. Go to a psychologist, as well. You can have a health care plan for that. And the most common treatment would be an antidepressant drug. And they’re usually serotonin reuptake inhibitors, where you take a medication that builds up the amount of serotonin in your brain and that would improve your mood. And for many people they work quite well. And if I need to prescribe a serotonin reuptake inhibitor antidepressant, I’ll always start with a very low dose and often that’ll work. But in treatment resistant patients, what happens is the doctor will say, “Well, you’re not really feeling better. So we need to increase the dose.” And they keep increasing the dose, increasing the dose, increasing the dose and then the side effects outweigh the benefits. And if you’re taking too much of an antidepressant, you will feel really, really tired and you’ll yawn a lot. That’s one of the giveaways.

VICTORIA: Wow! Okay.

DR CABOT: So, then the dose needs to be reduced.

VICTORIA: So how do you treat the treatment resistant depression?

DR CABOT: Well, you have to look at all the other factors that could be preventing the antidepressant medication from working. And that is often inflammation, which could be in the gut.

VICTORIA: Yeah, of course. And it could even be dysbiotic species degrading things. And actually, as you’re saying, raising the level of inflammation. Liver! We can’t discount liver involvement, also. Because if the people are not producing enough bile, that can also affect their gut microbiome that can create the depression. So, everybody, look at the liver! Whenever there’s doubt, go back to the liver.

DR CABOT: Because metaphysically, the liver is the seed of anger.

VICTORIA: Yes, and resentment. And who can be depressed and not resent being there?

DR CABOT: A lot of depressed people are angry and often justifiably so because life’s often not fair. But they don’t cope with anger well. So, if you’ve got anger and you turn it within, then you’ll get depression. When people say, “Oh, don’t go upsetting that person. He’s very liverish.”

VICTORIA: Yes.

DR CABOT: Because the liver is a seed of anger. So often by improving your liver function, through improving your diet, and taking a good liver tonic, you’ll improve your mood. So, don’t drink too much alcohol if you’re depressed.

VICTORIA: No, that’s a bit on the… It’s very sort of seductive to think that you drown your sorrows in the alcohol. But you drown your liver and increase the long-term anger, resentment and regrets. And it’s those regrets you can have a lot.

DR CABOT: Yes. So, alcohol indulgence and excess can be a symptom of depression.

VICTORIA: Of course.

DR CABOT: So, get help. Be around people who don’t drink too much. And you can always go to AA and learn to do new things in your life to try and stimulate yourself. But when you’re depressed, you don’t have the motivation. You’ve got to force yourself. It’s a bit like a robot – one foot in front of the other. But by looking after your liver and your gut every day, you’ll start to improve. And it’s interesting, if you’ve got really bad gut bacteria, a lot of yeast in your gut and a lot of bacteria in your small intestine that are overgrowing – we call it small intestinal bacterial growth – they release toxins, cause a leaky gut. Then you get a leaky blood brain barrier. Then you get brain inflammation.

VICTORIA: That’s exactly right! And that’s just the breeding ground of severe depression.

DR CABOT: It is. And research has shown that there’s an excessive inflammatory chemicals in the brain of depressed patients. So, things like cytokines and interleukins, all these complicated inflammatory chemicals are present in excessive amounts in the brain of people with mood disorders. So, we were talking about different diets for depression. And in people who have a lot of anxiety associated with depression, sometimes a ketogenic type of diet can be very beneficial.

VICTORIA: Great!

DR CABOT: Because it’s high in the healthy fats for the brain and high in amino acids. And your brain makes neurotransmitters out of amino acids.

VICTORIA: Correct.

DR CABOT: And by not eating the carbohydrates, you’re not feeding the bad bacteria in your gut. So, ketogenic diet can be quite amazing in improving your moods and reducing depression. We have a lovely Ketogenic Diet Guide on our website, which you can download.

VICTORIA: Yes. And I have heard of the voluminous research that has been done with ketogenic low carb, paleo diets and their benefits with bipolar. They’ve looked at bipolar, that it sort of tends to balance things out. But the treatment resistant, I hadn’t heard anything about that. But it’s definitely got benefits with bipolar.

DR CABOT: Yeah. If you’re finding that antidepressants are not working or you’re having to take really high doses, then you’re treatment resistant. You need to look at other factors that you’re missing, such as bad gut bacteria, an inflamed liver and brain inflammation.

VICTORIA: The other thing that might work that people often don’t think about, because they have a bit of trouble getting out of their own way – and it’s boring- it’s exercise! Because exercise actually raises endorphins, which are our opioids, our feelgood chemicals. So, forcing yourself out and moving is just great. But also, sunshine. Sunshine has got so many benefits, apart from vitamin D. I do tell people, they can be depressed as they like, but they’ve got to do it outside in the sunshine with a good cup of tea. And they can’t stay depressed.

DR CABOT: Well, people can have seasonal effective disorder, where they only get depressed in the winter, when their vitamin D plummets.

VICTORIA: And their melatonin.

DR CABOT: Yeah. So, they need to take vitamin D during the winter.

VICTORIA: Definitely!

DR CABOT: And have a blood test to check their vitamin D level. And if they’re not sleeping properly, in particular, if they’re having trouble falling asleep, take melatonin. You might need 3mg. You might need 10mg. It’s experimental, whatever dose you will need. But melatonin is “safe as”. You can take it. It’s not addictive and it actually has anticancer effects.

VICTORIA: Yes. It’s a very, very good antioxidant for gut bacteria. So, these things are not a one-use nutrients or chemicals. They work all over.

DR CABOT: That’s right! And looking at treatment resistant depression, there are some psychiatrists who really study this area, particularly. And they say, that unless you get rid of the anxiety, the depression may be resistant and it may hang around. So, they use small doses of benzodiazepines, like clonazepam or diazepam. They are sedatives and they’re not recommended long term, unless you’re using very small doses. But you’ve got to sleep. If you don’t sleep, you won’t get better from depression. So, to get you sleeping, sometimes we have to use a small dose of benzodiazepine. Or in people with really severe anxiety, we can use a small dose of an antipsychotic. Just very, very low dose, like something like a drug called Abilify. And psychiatrists will often use that. So, it’s good to know these things. Because if your GP doesn’t feel confident, you can go to a psychiatrist and they are better at prescribing the drugs, because that’s their specialty. But if you use nutritional medicine and lifestyle medicine, the wonderful thing is usually you won’t need big doses of these drugs and then you won’t get the side effects. So, if you’re needing more and more and more of a specific antidepressant, that means that it’s not really working well. And you either need to see a specialist psychiatrist or you need to look at other factors which are very, very important; such as is your depression much worse in the premenstrual phase? So, for women who get the premenstrual mood disorder, they need progesterone. The happy hormone. It’s wonderful. It relaxes you. It helps to stop that drop in mood in the 10 days before your period. And we prescribe it as cream.

VICTORIA: Right. What about postmenopausal women?

DR CABOT: Yeah. Well, a lot of women get depressed during menopause. No wonder, with hot flushes and dryness and weight gain and everything else.

VICTORIA: And the skin going!

DR CABOT: That’s right! So, years ago in medicine, they used to call postmenopausal depression involutional melancholia.

VICTORIA: Oh, my goodness. Okay.

DR CABOT: So that means everything’s turning inwards and shrinking and you’re getting sad. Well, it’s not very complimentary. But we want to avoid that because hopefully we’re all living much longer. And we don’t want to be sad from the age of 50 to 80. So, we don’t want this involutional melancholia and bioidentical hormones can help some women. Some women, they don’t make any difference. Some women, they make a big difference. So, we can use natural progesterone. We can use testosterone. So, if your blood test shows that you have very low testosterone levels, then it’s worth taking some testosterone in the form of a cream and just see if it elevates your mood.

VICTORIA: Okay, sure! Now with people with chronic fatigue and this fatigue that you’re talking about, is there possibility of DHEA helping those people?

DR CABOT: Yes, absolutely! DHEA is like a weak form of testosterone. It’s androgenic and some people find that it does rejuvenate their mood, DHEA. And it’s quite a safe hormone. You need a prescription in Australia. You don’t need a prescription in America. You can just buy it in a health food store.

VICTORIA: Well, that tend to indicate it’s fairly safe, then.

DR CABOT: Yeah, you’re right. And the testosterone, well you do need a script. But it is androgenic hormones can be very effective in some people with depression. And men, too. Some men who are depressed and particularly if they have a fatty liver, they have very low levels of testosterone. And when you give them testosterone, their depression goes.

VICTORIA: Oh, that’s very, very good news! Well, all you’ve got to… the problem there is getting the men to come in and admit that they’ve got a problem to start off with.

DR CABOT: That’s right! Men tend to put up with it, don’t they? Or have too many drinks to drown their sorrows.

VICTORIA: Yes. So, we can see a bit of a vicious cycle starting here.

DR CABOT: Yeah. So, in the brain there’s a lot of receptors for hormones. There’s receptors for progesterone, estrogen, testosterone. And they’re there for a reason. These sex hormones do have a balancing effect on your mood. So, if you have resistant depression, you need to look at hormonal factors. And perhaps you need some bioidentical hormones. And also with postnatal depression, hormonal treatment makes a big difference. And a patient gets better much quicker if you give them progesterone and testosterone. But it’s often not prescribed.

VICTORIA: That’s good because they’ve got a young, new person to be looking after. And when they don’t feel very good about themselves, it makes it very difficult to be the parent that they expected to be. So that’s really valuable information.

DR CABOT: Yeah, it is. Well, years ago, women used to eat their placenta because it was full of hormones and it would make them cope with looking after a newborn.

VICTORIA: I have heard that they are now capsulizing it and doing the same thing.

DR CABOT: Yeah. If you go online, you’ll see all over the world, there’s groups of midwives who specialize in collecting your placenta and turning it into capsules.

VICTORIA: Right. Do they dehydrate it? Or they just…

DR CABOT: Yes, I thought they would. I haven’t looked up the technique, but I do recommend it. Postnatal depression. You could save your placenta and use it because it’s a wonderful source of all these hormones. And particularly if you felt very happy during pregnancy because of the high hormones, you may as well keep that…

VICTORIA: Take advantage of…

DR CABOT: …the euphoria going. Because, as Victoria said, you really need to be up.

VICTORIA: That’s exactly right.

DR CABOT: …when you’re looking after a newborn. So, treatment resistant depression. The other thing that’s interesting, that psychiatrists are talking about, is in people who don’t respond to antidepressant drugs is a drug called Pramix… It’s hard to say… Pramipexole.

VICTORIA: Pramipexole? Ok, right. So what does it do?

DR CABOT: Well, the brand name is Sifrol, but it’s a dopamine agonist. In other words, it acts like dopamine, which is a neurotransmitter in the brain. And it’s sometimes used to treat Parkinson’s disease. It has to be started in very low dose and it can be taken with an antidepressant drug. It’s gradually increased and in some people it works very well, for treatment resistance.

VICTORIA: So, if people get benefit from that, would there be the possibility that you could wean them off that onto tyrosine, which is also a precursor to dopamine?

DR CABOT: Absolutely. And people with mild depression and they’re coping, they’re functioning. They may not want to start an antidepressant. You don’t have to panic. There’s lots of things you can try first. As we said, fix your diet, do some exercise, check your hormones, get some relief, reduce stress, get some help, counselling. And also try some natural things. Like tyrosine, is a good supplement to take; Tyrosine powder. It’s stronger than tablets and it acts in the body as a precursor for dopamine and adrenaline, which are neurotransmitters that have an antidepressant effect. So, you might need one teaspoon every 4 hours to get your dopamine up. You just take it in water, it doesn’t taste and you take it away from food. Tyrosine sometimes works very well. Fish oil can work because the omega 3.

VICTORIA: Anti-inflammatory.

DR CABOT: Magnesium very important for the brain, particularly if you’ve got anxiety. B vitamins.

VICTORIA: Well, everybody needs B vitamins and vitamin C.

DR CABOT: Yes! So, all those things can be tried and you don’t have to panic. Just make sure you see your doctor regularly because unfortunately, untreated depression can lead to suicide. It’s the most common cause of death in young people. Suicide. It’s not car accidents. And this is because people don’t seek help early enough and they’re not monitored closely enough. So, there’s many things you can do to bring back your old self, to bring back happiness. Because happiness is just having the right chemicals in your brain. But that depends on so many other things in your body, like your gut and your liver, your diet. And if you’ve got a lot of brain inflammation, you can also try a supplement called N-Acetyl Cysteine.

VICTORIA: How does that work?

DR CABOT: Well, that helps your liver to make glutathione and glutathione reduces inflammation. It’s a powerful anti-inflammatory. You might need to take a selenium supplement as well to really get the N-Acetyl Cysteine working. N-Acetyl Cysteine is abbreviated to NAC. You don’t need a prescription for it, and it’s often very helpful for people who have been using recreational drugs or too much alcohol, to keep them going with the depression. So, something to bear in mind, the N-Acetyl Cysteine. We’ve got that. We’ve got magnesium, we’ve got the B vitamins, we’ve got fish oil. And make sure you eat some folic acid.

VICTORIA: Folate, folate and activated folate. Because there’s a lot of people with MTHFR polymorphisms that have problems with their activating their folate. So, you can either, as you’ve told me many times, you can get activated folate from sprouted seeds and legumes. But now there’s more, like even in LivaTone Plus. There’s activated folate in those products so that it overcomes those polymorphisms. So that you get all those folates for your cellular integrity.

DR CABOT: And try and eat some green leafy stuff. If you don’t like it, make a juice. Put some carrot and beetroot in it. A bit of orange and lemon. And that’s giving you a big surge of antioxidants, which will reduce brain inflammation.

So, we hope you’ve found this helpful. As you can see, depression is a very complicated illness. It’s horrible to be depressed. Don’t put up with it. It’s easier to put up with pain than it is with chronic depression. Life is just not worth living. So don’t fight it alone. Try and get help from a GP or a good psychiatrist. And as always, you can email us if you have any questions. We’re here to help.

So, thanks for listening and have a wonderful day. Thank you, Victoria!

VICTORIA: And thank you all very much for listening. Good bye now.