Folic acid (folate). Folic acid, another B vitamin, helps assist in the creation of many neurotransmitters. It is also essential to the production of hemoglobin, the oxygen-bearing substance in red blood cells, so deficiencies often lead to anemia. Studies have shown abnormally low levels of this vitamin in from a quarter to a third of all depressed persons. Other symptoms include fatigue, lower-extremity problems, and dementia. Orthomolecular psychiatrists have used folic acid supplements for many years to reduce the frequency of relapses in their patients. Poor dietary habits contribute to folic acid deficiencies, as do illness, alcoholism, and various drugs, including aspirin, birth control pills, barbiturates, and anticonvulsants. It is usually administered along with vitamin B12, since a B12 deficiency can mask a folic acid deficiency. The usual dose is 800 mcg. Higher doses, though safe, require a prescription.
Vitamin C (ascorbic acid). Vitamin C, widely known for its antioxidant abilities, is also important for mental health. Subclinical deficiencies can produce depression, which requires the use of supplements. One study showed that a single 3-gram dose of vitamin C reduced symptoms by 40 percent in eleven manic and twelve depressed patients after only four hours. Supplementation is particularly important if you have had surgery or an inflammatory disease. Stress, pregnancy, and lactation also increase the body's need for vitamin C, while aspirin, tetracycline, and birth control pills can deplete the body's supply. A good maintenance dose is 1 to 3 grams daily, with more for depressed people, smokers, and those exposed to toxins of various kinds.
There are at least fifteen minerals that are essential to health. Either inadequate or excessive dietary intake can lead to mental and behavioral problems, including depression, often before any physical symptoms appear.
Minerals important to mental health include:
- Sodium and potassium. These minerals are considered together because they determine the body's electrolyte balance, which regulates water levels. Eating a lot of salty food (sodium) disrupts this balance. This not only produces high blood pressure, but also affects neurotransmitter levels, producing depression and PMS. In addition, the misuse of diuretics, or "water pills," can lead to potassium deficiency, which in turn can manifest itself as depression. A good daily dose is from 200 to 400 mg.
- Iron. Iron deficiency can result in anemia, which can produce symptoms such as depression, irritability, fatigue, loss of attention span, and insomnia. One study found that nearly half of all premenopausal women and a third of all children do not get enough iron, so supplementation in these groups could have a significant impact on the frequency of depression and other disorders. From 15 to 30 mg a day is a good maintenance dose. On the other hand, excessive iron can lead to toxicity, especially in men, who are not losing the mineral regularly through menstruation. Therefore, men shouldn't supplement with iron unless under a doctor's direction.
- Magnesium. This mineral assists in all of the body's energy reactions.
Deficiency can result in depressive symptoms, along with confusion, agitation, anxiety, and hallucinations, as well as a variety of physical problems. Most diets do not include enough magnesium, and stress also contributes to magnesium depletion. Other possible reasons for a deficiency include kidney or parathyroid disease, high blood pressure, chronic fluid loss, alcoholism, and malabsorption disorders. Several studies have shown that magnesium injections can bring relief from symptoms such as fatigue, aches and pains, weakness, and lethargy. I frequently give magnesium shots for migraine headaches, PMS, and allergies. A daily maintenance dose is 400 to 800 mg, with more needed to correct deficiencies.
- Calcium. Depressed individuals often have excessive calcium levels, particularly those with bipolar disorder (see Chapter 2). When these patients recover, their calcium levels usually return to normal. Depression can also occur in cases of calcium deficiency, long before the appearance of physical deficiency symptoms. In addition, calcium works with magnesium to maintain balance, or homeostasis, in the body, much as sodium and potassium work together to achieve balance in water levels. If you are supplementing with calcium, you will need to take one-half as much magnesium, sometimes even more, to keep the two properly balanced. This includes women who are taking calcium supplements to prevent osteoporosis. A good daily dose is 800 to 1,000 mg.
- Zinc. Zinc deficiencies frequently lead to depression, since this mineral is essential to many processes related to brain function. In addition to irritability, mental slowness, and emotional disorders, zinc deficiency can produce changes in taste and smell sensations, a loss of appetite, reduced immune function, and rough skin. These symptoms are particularly common among older people and in women, especially those with eating disorders. An excellent treatment for anorexia and bulimia uses high doses of zinc, beyond the recommended 15 to 30 mg daily.
There are two other nutrients that are important to mental health. S-adenosylmethionine (SAM), a natural, active form of the amino acid methionine, helps process a wide variety of neurotransmitters, including norepinephrine, dopamine, phosphatidylcholine, serotonin, and melatonin. In Europe, SAM is sold as an antidepressant, where it performs as well or better than synthetic drugs without the side effects.
Phosphatidylserine, another substance that is particularly plentiful in the brain, helps to ensure proper nerve function by keeping the membrane surrounding each brain cell fluid and flexible. Proper membrane fluidity affects nerve signal transmission, the binding of neurotransmitters to receptor sites, and the activity of monoamine oxidase, or MAO. Phosphatidylserine can also enhance mood, behavior, and mental function by increasing the accumulation, storage, and release of several neurotransmitters. I have used it successfully in my practice as an adjunct in treating depression and to improve cognitive functions such as thinking and memory, in doses of 100 mg two to three times a day. It should not be combined with an antidepressant without a doctor's supervision, nor is it recommended for bipolar disorder.
Other Possible Causes of Depression
There are several illnesses that can mimic depression, including chronic fatigue syndrome, systemic candidiasis, and hypoglycemia, or low blood sugar. St. John's wort can be especially useful in treating the first two disorders; both are related to immune dysfunction, and St. John's wort can fight depression and strengthen the immune system (see St. John's Wort - The Versatile Herb). Two additional factors to consider in depression are hormonal imbalances and the effects of pollution. (See Solving the Puzzle of Chronic Fatigue Syndrome by Michael Rosenbaum, M.D. and Murray Susser, M.D.)
Chronic Fatigue Syndrome
Chronic fatigue syndrome (CFS) is an often-baffling disorder that can thoroughly disrupt someone's life, as Melissa discovered.
Melissa, a successful 38-year-old professional, described herself in desperate terms: "I feel like I'm losing my mind. I'm absent-minded, simple tasks overwhelm me, and I'm in tears at the drop of a hat. I'm exhausted most of the time. I can barely get up in the morning. All day, there's a constant struggle to stay awake. I feel my life is over!"
Melissa's medical history revealed unaddressed explanations for her desperation. Six months earlier, she'd had the flu. Despite her apparent recovery after about a month, she never fully regained her former strength and energy. She could no longer exercise as before, and found that it depleted rather than energized her. She drank coffee to boost her energy, but after a while even that did not work.
I ordered several blood tests. They revealed a number of problems, any one of which could cause fatigue, anxiety, and depression: iron-deficiency anemia, elevated Epstein-Barr viral antibodies-which indicated both a past and presently active viral infection-and hypoglycemia. I prescribed an iron supplement for the anemia, a standard medical diagnosis that is often overlooked. However, in contrast to standard treatment, I also prescribed immune-boosting and energizing herbs, including astragalus, echinacea, goldenseal, licorice, and Siberian ginseng. In addition, Melissa took St. John's wort, mega-doses of vitamins and minerals, and specific amino acids, especially lysine and cysteine, for viral defense. Within three months she was feeling like herself again-active, enthusiastic, optimistic, and no longer depressed.
Melissa's flu turned out to be Epstein-Barr virus, a chronic, relapsing form of infectious mononucleosis that is part of CFS. CFS appears to be caused by any one of a group of viruses that can lie dormant for months or years at a time, then be reactivated by physical or emotional stress. Symptoms include depression, extreme fatigue, nonrestorative sleep, impaired memory and concentration, anxiety attacks, intermittent low-grade fevers, sore throat, swollen lymph glands, muscle aches and pains, and allergies. One feature that distinguishes CFS from depression or other causes of fatigue is a negative response to exercise. While most individuals feel energized after exercise, chronic fatigue patients feel worse.
Systemic Candidiasis (Candida Infection)
Systemic candidiasis is caused by the fungus Candida albicans, an organism normally found in the intestines and elsewhere that can grow out of control under certain conditions. Joni is a good example of how candidiasis can affect mood.
Joni, an overweight, depressed, 32-year-old secretary, was in tears. "Everything I eat makes my stomach bloat like I'm six months' pregnant. I keep dieting, and I can't lose weight. My brain is like mush: I'm absent-minded, and afraid I'm going to lose my job. Yesterday, I went to get coffee for my boss, went to the file drawer instead, and couldn't remember what I was doing!" She craved sugar and bread, and had repeated vaginal yeast infections and severe PMS. She scored high on a candida questionnaire, and a candida antibody blood test confirmed the diagnosis.
Joni had taken antibiotics as a teenager to combat acne. This set her up for overgrowth of yeast in the intestinal tract. She had also started taking birth control pills at the age of twenty-four, leading to a hormonal state that favors candida growth. Fortunately, she responded well to treatment, which included a healthy diet, two acidophilus capsules a half hour before each meal, and two tannic acid capsules taken three times daily. Her abdominal bloating cleared, as did her PMS, mood swings, and mental fogginess. She was finally able to lose weight, as well.
Systemic candidiasis, also known as chronic Candida albicans or candida hypersensitivity syndrome, is similar to CFS in its effects. Candida albicans is normally kept in balance within the gastrointestinal tract by the friendly bacteria that aid in digestion, such as acidophilus. If these friendly bacteria are weakened, candida can start to overgrow, causing a multitude of symptoms that are often erroneously labeled psychosomatic.
As in Joni's case, long-term use of antibiotics kills the body's friendly bacteria, making it easier for candida to overgrow. When used with steroids, antibiotics also suppress the immune system. Repeated pregnancies and prolonged use of either birth control pills or progesterone can change the body's hormonal balance, which can also lead to candidiasis. A diet high in sugar will promote candida growth, both because the yeast grows on sugar and because sugar has an immune-suppressant effect.
Like CFS, candidiasis is a controversial diagnosis in orthodox medical circles, usually acknowledged only in severely debilitated patients. For more information on this subject, see The Yeast Connection by William Crook, M.D. and The Yeast Syndrome by John Parks Trowbridge, M.D.