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Depression - Dr. Mark Hyman

Mark Hyman MD The UltraMind Solution: How can exercise and fish oil often be a more effective treatment for depression than antidepressants? Could it be because they are both potent anti-inflammatories? Could it be that depression is a low-grade inflammatory disease of the brain 1? Let's look at the evidence1.
1. Proinflammatory cytokines IL-1, IL-6, and TNF ? (molecular messengers that set off the inflammatory response) and bacterial toxins (produced in our gut) produce symptoms of depression and anxiety.
2. Cytokines overactivate the HPA (hypothalamic-pituitary-adrenal) axis (the stress response) just like we find in depressed patients.
3. Cytokines increase the function of an enzyme (IDO) that breaks down tryptophan, leading to less serotonin in the brain3. Serotonin is the happy mood chemical that fights depression.
4. The immune system is overactive in severe depression, producing brain inflammation.
5. Using immune therapy like interferon (a cytokine) for diseases like hepatitis C or multiple sclerosis triggers depression.
6. Depression is more common in inflammatory diseases like autoimmune and heart disease.
As compelling as these pieces of information are, they are not the only indications that depression is caused by an inflamed brain.
A new technique called vagal nerve stimulation is very helpful in depression 4. The vagus nerve is your calming, relaxation nerve. When you take a deep breath, meditate, or do yoga the vagus nerve is activated, and it releases acetylcholine, which reduces the production of inflammatory cytokines.
There may be many reasons deep breathing and relaxation work, but certainly one of them is the fact that inflammation is reduced.
We also know that omega-3 fats help depression and produce remission 5. They work by lowering inflammation and also through their effects on cell membranes and cell communication.
Similarly, we know that exercise is an anti-inflammatory and works better than Prozac in treating depression6.
Another example comes out of Harvard. A group of researchers there discovered an increased number of "white matter lesions," or little white spots in the brain that are seen in autoimmune diseases like multiple sclerosis in depressed patients. This correlated with low levels of folate, which caused high levels of homocysteine, a molecule that triggers inflammation in the brain7. So being vitamin deficient produces toxic molecules that inflame the brain and cause depression.
Of course, we must ask, "Which came first, the chicken or the egg? Does depression cause inflammation or inflammation cause depression?"
The answer is yes. It is a vicious cycle. Inflammation leads to depression, which leads to more inflammation.
The message is that to adequately treat depression we must look for, find, and eliminate the causes of inflammation and then help the body create balance in the immune system turning off this vicious cycle.

Depression or Hormonal Imbalance?
Let me tell you the story of a patient of mine with PMDD. She was barely able to function. She suffered three weeks out of every month with severe physical symptoms and debilitating depression. Was she Prozac deficient? I think not.
She was thirty-seven years old. Many women feel worsening PMS symptoms as they get in their later reproductive years, because of changes in hormonal cycles. Part of what this particular woman experienced was severe depression, fatigue, anxiety, and food and sugar cravings that led to overeating and weight gain.
She also had joint pains, breast tenderness, heavy bleeding, hot flashes, dry skin, acne, hair loss, trouble with memory, poor sleep, and no sex drive.
She didn't drink alcohol but was a big coffee drinker. She started the day with a bagel and cheese; had a cafeteria lunch; indulged in chocolates in the afternoon; and ate a healthy dinner followed by binging on ice cream, chips, and Cheerios.
She also complained of gas and bloating.
She also ate a lot of dairy.
This is a story I hear all too often. The good news is that there was a simple solution for her that didn't involve taking medication.
We know that sugar, caffeine, alcohol, stress, and lack of exercise all contribute to worsening PMS1 and all hormonal imbalances, including menopause and andropause.2
It is also true that dairy consumption can worsen hormonal imbalances because of all the hormones in milk. Even organic milk3-4 can come from pregnant cows–jacking up hormone levels.5
I helped her change her diet, cut out the sugar and caffeine, eliminate her food allergens, take a few supplements and herbs, do a little exercise, and within one menstrual cycle her life changed.
All her symptoms resolved, she lost weight and dramatically increased her energy. Her mood stabilized (meaning her depression evaporated), and her acne and dry skin went away. All without medication.

For more information on depression, please see Dr. Hyman's new book, The UltraMind Solution..

Das UN. Is depression a low-grade systemic inflammatory condition? Am J Clin Nutr. 2007 Jun;85(6):1665-6.
Anisman H, Merali Z. Cytokines, stress and depressive illness: brain-immune interactions. Ann Med. 2003;35(1):2-11. Review.
Müller N, Schwarz MJ. Immunological aspects of depressive disorders. Nervenarzt. 2007 Nov;78(11):1261-1273.
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Parker G, Gibson NA, Brotchie H, Heruc G, Rees AM, Hadzi-Pavlovic D.Omega-3 fatty acids and mood disorders. Am J Psychiatry. 2006 Jun;163(6):969-78. Review.
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Papakostas GI, Iosifescu DV, Renshaw PF, Lyoo IK, Lee HK, Alpert JE, Nierenberg AA, Fava M. Brain MRI white matter hyperintensities and one-carbon cycle metabolism in non-geriatric outpatients with major depressive disorder (Part II). Psychiatry Res. 2005 Dec 30;140(3):301-7. Epub 2005 Nov 16.