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methylation, which is critical for balancing the neurotransmitters dopamine and adrenalin. A study at King's College Hospital in London found that giving folic acid supplements to people with borderline or low folic acid levels alongside standard drug treatment significantly improved recovery in patients with depression.[9] Their research found that a third of all people with depression and other psychiatric disorders were deficient in folic acid. Giving vitamin C has also been shown to enhance recovery.[10] Why women are more depressed? There are often two sides to feeling blue — feeling miserable, and feeling apathetic and unmotivated. The most prevalent biochemical theory for the cause is a brain imbalance in two families of neurotransmitters — the molecules of emotion. These are serotonin, which influences mood, and adrenalin and noradrenalin, made from dopamine, which influence motivation. Women are three times as prone to low moods as men. Many theories as to why have been proposed, some psychological, some social. However, women and men are biochemically very different, as the research of Mirko Diksic and colleagues at McGill University in Montreal has demonstrated. They developed a technique using PET neuro-imaging to measure the rate at which we make serotonin in the brain and found that men's average synthesis rate of serotonin is 52 per cent higher than women's.[11] This, and other research, has clearly shown that women are more prone to low serotonin. The serotonin story It has been learned in the last few years that there are six main reasons for deficiency in serotonin (in addition to a lack of the amino acid that makes it): not enough oestrogen (in women); not enough testosterone (in men); not enough light; not enough exercise; too much stress, especially in women; not enough co-factor vitamins and minerals. If people are suffering from low mood, feel tense and irritable, are low in energy, tend to comfort eat, have sleeping problems and a reduced interest in sex, and any of the above six main reasons for deficiency, the chances are they are short on serotonin. Low oestrogen means low serotonin and low moods[12],[13] because oestrogen blocks the breakdown of serotonin. This may largely explain why women are more prone to depression premenstrually and in the menopause and thereafter. Low testosterone has a similar effect in men. Light stimulates oestrogen, and most of us don't get enough of it. The difference in light exposure outside and inside is massive. Most of us spend Stress also rapidly reduces serotonin levels. Physical exercise improves stress response, and therefore reduces stress-induced depletion of serotonin. Diet for depression A safer alternative to antidepressant drugs like Prozac (which stop the body breaking down serotonin, therefore keeping more circulating in the brain) would be to eat foods from which the body makes serotonin. Serotonin is made from a constituent of protein, the amino acid tryptophan. Supplementing the amino acid tryptophan is already well proven to improve mood. Donald Ecclestone, professor of medicine at the Royal Victoria Infirmary in Newcastle, reviewed the available studies and concluded that supplementing tryptophan leads to an increase in the synthesis of serotonin in the brain, improving mood.[14] Even more effective is a derivative of tryptophan that is one step closer to serotonin. This is called 5-hydroxytryptophan, or 5-HTP for short, and is derived from an African plant called griffonia. The first study proving the mood-boosting power of 5-HTP was done in the 1970s in Japan, under the direction of Professor Isamu Sano of the Osaka University Medical School.[15] He gave 107 depressed patients 50—300mg of 5-HTP per day and, within two weeks, more than half experienced improvements in their symptoms. By the end of the four week study, nearly three quarters of the patients reported either complete relief or significant improvement, with no side effects. This study was repeated by other researchers who found that 69 per cent of patients improved their mood.[16] Since then, studies have shown that this nutrient is as effective as the best antidepressants with a fraction, if any, of the side-effects. One double-blind trial headed by Dr Poldinger at the Basle University of Psychiatry gave 34 depressed volunteers either the SSRI antidepressant fluvoxamine, or 300mg of 5-HTP. Each patient was assessed for their degree of depression using the widely accepted Hamilton Rating Scale, plus their own subjective self assessment. At the end of the six weeks, both groups of patient had had a significant improvement in their depression. However, those taking 5-HTP had a greater improvement in each of the four criteria assessed — depression, anxiety, insomnia and physical symptoms — as well as in self assessment.[7] Given that 5-HTP is less expensive and has significantly fewer side effects, it is extraordinary that psychiatrists, despite plenty of scientific evidence that it helps restore normal mood and normal serotonin levels, almost never prescribe it. The recommended dosage of this natural supplement, available in any health food shop, is 100mg of 5-HTP, twice a day, for depression. Some supplements also provide various vitamins and minerals such as vitamin B3, B6 and folic acid, which may be even more effective because these nutrients help to turn 5-HTP into serotonin. A new understanding of apathy Deficiency in the neurotransmitter adrenalin, and its brother, noradrenalin, is, as mentioned, also associated with depression, and lack of motivation. They are made from dopamine, which is made from the amino acid tyrosine, which is made from the amino acid phenylalanine. If drugs that block the breakdown of these neurotransmitters elevate mood, then supplementing the amino acid phenylalanine or tyrosine might work too, without the side effects. And they do. In a double-blind study by Helmut Beckmann and colleagues at the University of Wurzburg in Germany, 150—200mg of the amino acid phenyalanine or the antidepressant drug imipramine were administered to 40 depressed patients for one month. Both groups had similar positive results — less depression, anxiety and sleep disturbance.[17] The military has long known that tyrosine improves mental and physical performance under stress. Recent research from the Netherlands demonstrates how tyrosine gives an edge in conditions of stress. Twenty one cadets were put through a demanding one week military combat training course. Ten cadets were given a drink containing 2g of tyrosine a day, while the remaining 11 were given an identical drink without the tyrosine. Those on tyrosine consistently performed better, both in memorising the task at hand and in tracking the tasks they had performed.[18] The best results of all are achieved by supplementing all of these amino acids —5-HTP, phenylalanine and tyrosine — together with the B vitamins B3, B6, B12 and folic acid, which helps turn them into neurotransmitters. The master tuners TMG (tri-methyl-glycine) and SAMe (s-adenosyl methionine) are also types of amino acids. They help to keep the brain and nervous system well tuned and, together with B vitamins, can make all the difference. SAMe is one of the most comprehensively studied natural antidepressants. Over a hundred placebo-controlled, double-blind studies show it is equal or superior to antidepressants, works faster, most often within a few days (most pharmaceutical antidepressants may take three to six weeks to take effect) and with few side-effects.[19],[20].[21] Between 200 and 600mg a day is required but it is both very expensive and very unstable — a lot of SAMe sold in health food shops is pretty ineffective. TMG is much more stable and less costly. In the body it turns into SAMe, but three times as much needs to be supplemented. I recommend 600 to 2000mg a day, on an empty stomach or with fruit. Mood-boosting fats Omega-3 fish oils are very much part of my equation for happiness. The higher the blood levels of omega-3 fats, the higher the levels of serotonin are likely to be. This is because omega-3 fats help build receptor sites, as well as improving reception. According to Dr J R Hibbeln, who discovered that fish eaters are less prone to depression, "It's like building more serotonin factories, instead of just increasing the efficiency of the serotonin you have".[22] A recent trial published in the American Journal of Psychiatry tested the effects of giving 20 people (already on antidepressants but still depressed) a highly concentrated form of omega-3 fat called ethyl-EPA. By the third week, the depressed patients were showing major improvement in their mood, while those on placebo were not.[23] Working wonders The combination of the 'optimum nutrition' approach and effective psychotherapy works wonders for a wide variety of mental health problems, from depression to schizophrenia. Most of the psychiatrists I work with find that, while drugs can sometimes be life saving in the short term, they become unnecessary with the right combination of nutrients and psychological counselling and support. The need for essential nutrients is a human given, which, in our modern age of intensive farming, fast food and so on, has become less easy to fulfil. Helping people find ways to meet their need for essential nutrition, alongside helping them understand and meet their emotional needs, should form the basis of an enlightened approach to mental health. © Human Givens Publishing Limited and Patrick Holford (2003) |
This article first appeared in Volume 9, No, 4 (2003) of the Human Givens journal PATRICK HOLFORD is founder of the Institute of Optimum Nutrition, the largest UK training school for nutrition consultants. He trains doctors and health practitioners in nutrition and is author of 20 books. His latest, Optimum Nutrition for the Mind (Piatkus, £16.99) is published in January.
> A helpful CD which helps with relaxation is:
> You can find out more on the issues raised in this article on the following related pages:
> A helpful CD which helps with relaxation is:
> You can find out more on the issues raised in this article on the following related pages:
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