Depression: Symptoms, Causes, Treatments. How To Treat It?

Depression is an illness characterized by great sadness, a feeling of hopelessness, or a loss of motivation.

What are the different forms of possible depressive disorders? Its causes and prevalence?

And how to get out?

Depression, what is it?

Depression is a disease that is characterized in particular by great sadness, a feeling of despair (depressed mood), a loss of motivation and decision-making faculties, a decrease in the feeling of pleasure, eating and sleeping disorders, morbid thoughts, and the feeling of having no value as an individual.

In the medical community, the term major depression is often used to designate this disease. Depression usually occurs as depressive periods that can last for weeks, months, or even years. 

Depending on the intensity of the symptoms, the depression will be classified as mild, moderate, or major (severe). In the most severe cases, depression can lead to suicide.

Depression affects mood, thoughts, and behavior, but also the body. 

Depression can be expressed in the body by back pain, stomach pain, and headache; This also explains why a person who suffers from depression may be more vulnerable to colds and other infections, as their immune system is weakened.

Depression or depression?

The term “depression”, still taboo not so long ago, is often wrongly used in everyday language to describe the inevitable periods of sadness, boredom, and melancholy that everyone is called upon to experience at one time. another without it being a disease.

For example, being sad after the loss of a loved one or having a feeling of failure when faced with problems at work is normal. 

But when these moods come back every day for no particular reason or persist for a long time even with an identifiable cause, it can be depression. Depression is in fact a chronic illness, meeting very specific diagnostic criteria.

In addition to sadness, the depressed person maintains negative and demeaning thoughts: “I’m really bad”, “I’ll never make it”, and “I hate what I am”. 

She feels worthless and finds it difficult to project herself into the future. She no longer has an interest in activities that were once enjoyed.

The different forms of depression

Depressive disorders are classified into several entities: major depressive disorders, dysthymic disorders, and depressive disorders not otherwise specified.

major depressive disorder

It is characterized by one or more major depressive episodes (depressed mood or loss of interest for at least two weeks associated with at least four other symptoms of depression).

Dysthymic disorder (dys = dysfunctional and thymia = mood)

It is characterized by a depressed mood present most of the time for at least two years, associated with depressive symptoms that do not meet the criteria for a Major Depressive Episode. It is a depressive tendency, without there being a major depression.

Nonspecific depressive disorder is a depressive-like disorder that does not meet the criteria for major depressive disorder or dysthymic disorder. 

This may be, for example, an adjustment disorder with a depressed mood or an adjustment disorder with both an anxious and depressed mood.

Other terms are used alongside this classification from the DSM4 (classification manual of mental disorders).

Anxious depression

Along with the usual symptoms of depression are added excessive apprehension and anxiety.

Bipolar disorder previously referred to as manic depression

This psychiatric disorder is characterized by periods of major depression, with manic or hypomanic episodes (exaggerated euphoria, overexcitement, inverted form of depression).

Seasonal depression

Depressive state that manifests itself cyclically, usually during the few months of the year when the sun is at its lowest.

Postpartum depression

In 60% to 80% of women, a state of sadness, nervousness, and anxiety manifests itself in the days after childbirth. 

We are talking about baby blues which lasts between one day and 15 days. Usually, this negative mood resolves on its own. However, in 1 in 8 women, real depression sets in immediately or appear within a year of birth.

Depression following bereavement. In the weeks following the loss of a loved one, signs of depression are common, and this is part of the grieving process. However, if these signs of depression persist for more than two months, or if they are very marked, a specialist should be consulted.

Prevalence of depression

Depression is one of the most common psychiatric disorders. According to a survey conducted by public health authorities in Quebec, approximately 8% of people aged 12 and over reported having experienced a period of depression in the past 12 months. According to Health Canada, approximately 11% of Canadian men and 16% of Canadian women will suffer from major depression during their lifetime. 

And 7.5% of French people aged 15 to 85 have experienced a depressive episode in the last 12 months.

According to the World Health Organization (WHO), by 2020, depression will become the second leading cause of disability worldwide, after cardiovascular disorders.

Depression can occur at any age, including childhood, but most often first appears in late adolescence or early adulthood.

The causes of depression

It is not known precisely what causes depression, but it is probably a complex illness involving several factors related to heredity, biology, life events as well as environment, and habits. of life.

Genetic

As a result of long-term studies carried out on families as well as on twins (separated or not at birth), it has been possible to demonstrate that depression has a certain genetic component, although it has not been identified specific genes involved in this disease. Thus, a family history of depression may be a risk factor.

Biology

Although the biology of the brain is complex, we observe in depressed people a deficit or an imbalance of certain neurotransmitters such as serotonin. These imbalances disrupt communication between neurons. 

Other problems, such as hormonal disruption (hypothyroidism, taking birth control pills, for example), can also contribute to depression.

Living environment and habits

Bad lifestyle habits (smoking, alcoholism, little physical activity, excessive television or video games, etc.) and living conditions (precarious economic conditions, stress, social isolation) are likely to have a profound effect on psychological state. 

For example, the accumulation of stress at work can lead to burnout and ultimately depression.

life events

The loss of a loved one, divorce, illness, loss of a job, or any other trauma can trigger depression in people predisposed to the disease. Similarly, abuse or trauma experienced in childhood makes people more susceptible to depression in adulthood, especially because they permanently disrupt the functioning of certain stress-related genes.

Complications of depression

Complications related to depression

There are several possible complications related to depression:

  • recurrence of depression;

It is common since it affects 50% of people who have experienced depression. Treatment considerably reduces the risk of recurrence.

  • the persistence of residual symptoms;

These are cases where the depression is not fully cured and where even after the depressive episode, signs of depression persist.

  • the transition to chronic depression;
  • suicide risk.

Depression is the leading cause of suicide: about 70% of people who die by suicide suffer from depression. 

Depressed men over the age of 70 are the people most at risk of committing suicide. Thoughts of suicide sometimes called “dark thoughts”, are one of the signs of depression. 

Although most people with thoughts of suicide do not attempt it, it is a warning sign. Depressed people think of suicide to end the suffering that seems unbearable to them.

Disorders associated with depression

Depression has physical or psychological links to other health problems:

  • anxiety ;
  • addiction ;

Alcoholism, abuse of substances such as cannabis, ecstasy, and cocaine, and dependence on certain drugs such as sleeping pills or tranquilizers.

  • increased risk of certain diseases.

Including cardiovascular disease and diabetes. Indeed, depression is associated with a higher risk of heart problems or strokes. Moreover, suffering from depression could slightly accelerate the onset of diabetes in people already at risk.

Researchers argue that people with depression are also less likely to exercise and eat well. Also, some medications can increase appetite and cause weight gain. All of these factors increase the risk of type 2 diabetes.

Depression is recognizable by common signs in all individuals who suffer from it.

However, if it is a child, a teenager, or an elderly person, the symptoms may appear differently.

Symptoms of Depression

According to the DSM4-R definition, the main feature of depression is:

  • depressed mood;
  • with loss of interest or pleasure in almost all activities;
  • for a period of at least two weeks.

In a depressed child or adolescent, one can sometimes observe irritability rather than sadness. For depression to be effective, for the diagnosis to be made, the person must also present at least four additional symptoms:

  • a change in appetite or weight, sleep, and psychomotor activity;
  • reduced energy;
  • thoughts of worthlessness or guilt;
  • trouble thinking, concentrating, or making decisions.

Other symptoms may be present:

  • an unusual aggressive attitude or great irritability;
  • excessive emotional sensitivity (a trifle brings tears);
  • restlessness, with the impossibility of remaining seated, wandering, wriggling of the hands, manipulation, and friction of the skin, clothing or other objects) or on the contrary the impression of thinking and acting “in slow motion”;
  • a decrease in libido;
  • headaches, stomach or back pain;
  • a feeling of emptiness;
  • an impression of not feeling anything anymore.

These symptoms of depression are accompanied by significant distress or impairment in social, occupational, or other important areas of functioning.

Note: severe depression is often accompanied by other psychiatric problems, such as anxiety disorders, eating disorders (anorexia, bulimia), or drug or alcohol abuse. 
Indeed, many people with depression use these substances to relieve their symptoms, which can create other health problems (mental or physical).

In the elderly, depression is also common. It often goes unnoticed, because the symptoms (fatigue, loss of motivation, isolation) can be attributed to aging. A significant portion of this population would go undiagnosed and untreated. Some symptoms of depression are more common in older people than in younger people, in particular:

  • aggression and anger;
  • various and unexplained pains (backaches, headaches, etc.);
  • isolation, withdrawal;
  • confusion and memory problems;
  • the feeling of being useless, and frequent suicidal ideation.

Recognizing Depression in Children and Teens

In children

Depression is quite rare (0.5%) in their case. However, one must be particularly attentive to any sudden change in behavior and to signs of withdrawal, absence, or on the contrary, irritability or agitation:

  • he no longer wants to play, go out or see his friends;
  • he is very irritable and cries often;
  • he complains of headaches or stomachaches;
  • he says he no longer wants to live or that he shouldn’t have been born;
  • he experiences exclusion and failure at school;
  • he is growing, but gaining very little weight.

In adolescents

Depression can be difficult to distinguish from moments of crisis or confrontation specific to this stage of life. It affects 3% to 4% of adolescents, especially girls.

The following signs should be watched for:

  • abuse of alcohol, drugs, and medication;
  • a state of agitation;
  • verbal abuse;
  • an apparent indifference;
  • a tendency to isolation;
  • disinvestment in studies;
  • signs of self-harm;
  • a verbalization of suicidal thoughts.

No one is immune to depression. But some people are said to be at higher risk.

Depression and people at risk

No one is immune to depression. But the following people would be slightly more at risk:

  • people with a family or personal history of depression;
  • people taking certain medications, such as psychostimulants, steroids, corticosteroids, anabolics, anticonvulsants, or birth control pills. Indeed, the progestins contained in the birth control pill can affect mood. If so, discuss it with your doctor.

From a sociological point of view, the following groups are more affected by depression:

The women

About twice as many women as men will suffer from depression at least once in their lifetime, although some marginal studies have sometimes found an equivalent frequency in both sexes. 

Women are more likely to consult than men when they have symptoms of depression, which could partly explain why the disease is more often diagnosed in them. 

Also, at least two hypotheses have been put forward to explain the phenomenon: the hormonal system of women, which is more likely to influence brain chemistry (for example, menopause may be associated with the onset of depression), and problems of poverty and most common domestic violence

Men

Men living alone.

Young people

The first depression often occurs in late adolescence or early adulthood. Suicide is the second leading cause of death among young people, after road accidents.

Old people

Between 15% and 20% of the elderly experience periods of depression. They often go unnoticed. Possible causes include loneliness, death of spouse or friends, physiological factors associated with aging, such as a significant drop in serotonin and other metabolic changes, and undernourishment, which can cause nutritional deficiencies contributing to depression (especially folic acid and vitamin B12).

homosexual people

Several data, including a major cohort study in New Zealand, indicate that gays, lesbians, and bisexuals are at greater risk of mental health problems, and more particularly of depression, anxiety disorders, and suicidal behavior.

People with a chronic illness

Having chronic pain (migraine or back pain, for example) or a disabling disease (diabetes, stroke, etc.) greatly increases the risk of depression, especially among young people.

Many risk factors can promote the onset of depression, whether in young people, adults, or the elderly.

You will find the list of these factors detailed below.

Risk factors for depression

  • Experiencing repeated losses (death of a spouse or parent, miscarriage, divorce or separation, loss of a job, etc.);
  • experience chronic stress. A busy schedule, chronic lack of sleep, etc. ;
  • feeling constantly overwhelmed and having the impression of losing control over one’s life;
  • consuming alcohol or drugs, including tobacco;
  • having experienced traumatic events in childhood (sexual abuse, mistreatment, neglect, having witnessed parental violence, etc.);
  • have nutritional deficiencies. Vitamin B6 deficiency (especially in women taking oral contraceptives), vitamin B12 (especially in older people and people who drink a lot of alcohol), vitamin D, folic acid, iron, omega-3 fatty acids, or certain amino acids could cause depression;
  • living in difficult conditions, receiving low wages or social assistance, being a single mother or father, being part of an Aboriginal community in Canada, living in a sensitive urban area in France 90 ;
  • having already experienced a major depression makes you more likely to experience another;
  • living with a depressed spouse or parent.

Resilience: knowing how to bounce back

Resilience is the ability to overcome difficult or tragic experiences: the loss of a loved one, fire, rape, accident, humiliation, etc. It requires a good dose of inner security and confidence in life. 

Psychiatrist Boris Cyrulnik, who brought this concept back into the public arena, called resilience “the art of navigating torrents”.

This mental attitude is built through the bonds of trust created with one or more important people. According to Boris Cyrulnik, resilience “is not a catalog of qualities that an individual possesses. 

It’s a process that, from birth to death, knits us incessantly with those around us”. Resilience seems to be acquired most easily during the first years of life. Later, it can still be achieved, but with more effort.

Sometimes, in cases of signs of depression without major depression, or in cases of dysthymia, it is enough to organize a healthier lifestyle regimen for a while, such as going to bed early, exercising more, and eating in a healthy way. balanced, to feel better.

But other means can help not to sink into depression, and especially to avoid relapses after a first depression. Indeed, several studies show that about half of people with depression experience it more than once in their lifetime.

Preventive measures for depression

Activities, relationships, spirituality

Exercising regularly and the intensity and frequency of exercise increase its effect. People who practiced regular physical exercise would even be protected from depression between 2 and 9 years after stopping this activity.

Do not hesitate to open up about how you feel about the people around you when you feel depressed.

If necessary, seek help from a trained psychologist, social worker, or psychotherapist (see Psychotherapy).

Don’t be too demanding of yourself.

Live in the moment. Avoid entertaining negative thoughts, dwelling on the past, or anticipating the future.

Practice mindfulness meditation (mindfulness-based cognitive therapy (MBCT) for depression developed to reduce bouts of depression.

Get to know each other better and undertake projects.

Overcome your fears and nurture a form of spirituality.

Feed

If you can’t end depression with food alone, you can probably make it worse with poor food choices. But we can also prevent relapse by making good choices. Depending on the case, a dietitian or osteopath can help establish the appropriate diet: Ensure an adequate daily intake of nutrients. 

According to nature therapist JE Pizzorno, the recommendations offered to the population in food guides to maintain optimal health remain the same in the event of depression. However, he recommends a multivitamin and mineral supplement.

Consume more fatty fish (such as mackerel, herring, and salmon), as their flesh is rich in omega-3 fatty acids, an essential nutrient.

Also, be sure to eat foods high in folic acids, such as organ meats, legumes, and dark green leafy vegetables. Some pasta and breakfast cereals are fortified with folic acid.

Finally, a study showed that the Mediterranean diet reduced the risk of depression.

A diet containing a lot of processed products increases the risk of depression by 58% in this study. On the contrary, the Mediterranean diet reduces the risk of depression by 30%. How can a diet affect depression so much? No doubt by providing omega-3s, antioxidants, folates, and perhaps other elements…

Relapse prevention

To prevent a relapse, it is advisable to continue all treatments (whether taking medication or natural health products as well as psychotherapy) from 6 months to 24 months after complete recovery.

If the treatment is stopped as soon as the person feels cured, the risk of relapse would exceed 50%. At this time, the disease may be more difficult to treat. 

There is also a greater risk that depression will become chronic, hence the importance of taking responsibility for preventing depressive episodes (treatment, psychiatric monitoring, psychotherapy, and lifestyle changes).

Medical treatment varies depending on the severity of the depression.

Depending on the needs, it will be psychotherapy, accompanied by taking anti-depressant medication.

These medical treatments are detailed below.

What treatments to fight against depression?

Dysthymia-like depression, mild to moderate depression can usually be treated effectively with psychotherapy. In the case of major depression, the recommended treatment is psychotherapy associated with taking an antidepressant drug.

Several recent studies have shown that antidepressant drugs are most effective in cases of major depression. In practice, however, antidepressants are often prescribed for mild depression.

Regardless of the severity of the depression, combining “conventional” medical treatment with therapy is effective.

Psychotherapy

Undertaking psychotherapy often helps to understand the meaning of his depression or, at least, what triggered it. Such therapy also makes it possible to find the means to feel better on a daily basis. 

We learn to react better to the trials and successes that punctuate existence. It is then possible to adopt behaviors that protect against a relapse 17 .

There are several psychotherapeutic approaches. Cognitive behavioral therapy is one of the most effective short-term methods for depression. Similarly, therapy based on mindfulness is a recent approach that has proven its worth.

But the effectiveness of the treatment is not only based on the type of approach. The personal commitment and the will of the depressed person, as well as the relationship of trust that he weaves with his therapist would be even more important success factors.

Antidepressant drugs

About Medications

Substances of natural or artificial origin capable of modifying the chemical balance of the brain are called psychotropic substances. Their action is exerted essentially on the synapses of the neurons, that is to say the spaces allowing the transmission of information between the neurons.

The term antidepressant is reserved for a group of psychotropic drugs whose action aims to eliminate depressive symptoms. Antidepressants are divided by class, according to the type of action they operate on the brain (blocking or stimulating this or that function). Each class of antidepressants has its pros and cons.

There are several classes of antidepressants. Here are the most frequently prescribed:

Imipramic antidepressants

Including clomipramine (Anafranil), amitriptyline (Elavil, Redomex, Laroxyl) and imipramine (Tofranil), dosulepine (Prothiaden), doxepin (Sinequan, Quitaxon), maprotiline ( Ludiomil), nortriptyline (Nortrilen). 

Used since the early 1960s, they cause a lot of side effects (drowsiness, weight gain, constipation, dry mouth, low libido, etc.). It is used less these days.

Selective serotonin reuptake inhibitors (SSRIs or serotonergic antidepressants)

Including citalopram (Celexa, Seropram), fluoxetine (Prozac), fluvoxamine (Luvox, Floxyfral), paroxetine (Paxil, Deroxat, Divarius) and sertraline (Zoloft). This is usually the first choice of treatment for severe depression. 

Their effectiveness is equivalent to that of tricyclic antidepressants, but they are better tolerated. However, they may be associated with certain side effects: agitation, nausea, nervousness, insomnia, headaches and decreased libido.

Serotonin and norepinephrine or noradrenaline reuptake inhibitors (SNRIs)

Such as venlafaxine (Effexor), Duloxetine (Cymbalta), Milnacipran hydrochloride (Ixel). They are among the most effective antidepressants because they act on two types of neurotransmitters at the same time. 

However, they can cause more side effects. Usually, they are used when other medications are insufficient to relieve symptoms.

MAOIs (monoamine oxidase inhibitors).

They are little used in France. Iproniazid phosphate (Marsilid), Moclobemide (Moclamine), Phenelzine (Nardelzine, Nardil).

Caution

According to an advisory issued by Health Canada, SSRI and SNRI-type antidepressants expose children and adolescents to an increased risk of suicidal thoughts or behavior (compared to a placebo). 

Health Canada specifies that these antidepressants are not indicated in children and adolescents, as studies have failed to prove their effectiveness in them.

Other reports indicate that they can cause agitation, hostile behavior and acts of self-harm in anyone who uses them, including adults. Taking such drugs must therefore be carefully monitored by the doctor.

Moreover, according to another study, taking antidepressants during the first trimester of pregnancy increases the risk of miscarriage by 68%78. Talk to your doctor if you are pregnant and taking any medications.

It is not easy to find a drug with an optimal therapeutic effect. To achieve this, it is sometimes necessary to experiment with different products for several weeks or months.

In addition, a significant proportion of people with depression respond poorly or not at all to antidepressants. The psychiatrist can then prescribe 2 drugs of different classes simultaneously.

Note on withdrawal from antidepressants

You should never stop treatment with antidepressants suddenly, because they can cause symptoms if you stop. The dose should therefore be reduced gradually over a few weeks, following the doctor’s advice. 

That said, there are normally no dangerous withdrawal symptoms with antidepressants, only temporary discomfort.

It is desirable, but not always essential, to wait a few days (or more, depending on the drug) before undertaking another pharmacological or natural treatment. Ask your doctor.

Support or self-help groups

Group psychotherapy sessions are organized in hospitals, clinics and even in private offices as part of brief therapy (12 to 15 weeks). For depressed people, this is a way to break isolation or maintain a valuable social bond. There are also groups for loved ones of people living with depression.

Please note: depression requires diagnosis and follow-up by a health professional. Self-medication is therefore not recommended.

St. John’s wort, SAMe and 5-HTP can interact with antidepressants, increasing their effect, for example. Their consumption should be supervised by a health professional.

Refer to the complete fact sheets for these products for specific information on potential drug interactions.

Complementary approaches for depression

St. John’s wort (St. John’s wort)

The antidepressant role of St. John’s wort has been demonstrated by several clinical trials and meta-analyses.

Three meta-analyses have confirmed that the plant is more effective than a placebo in cases of mild to moderate depression and that it is as effective as synthetic antidepressants, while causing fewer adverse effects than the latter.

Antidepressants with which St. John’s wort has been compared in clinical trials include those of the fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) type, as well as older class drugs such as imipramine. A meta-analysis also concluded that St. John’s wort and SSRIs were equally effective.

When it comes to severe depression, studies have shown conflicting results. The authors of a meta-analysis examined 12 studies: they concluded that the effect of St. John’s wort in these cases was minimal. However, a subsequent study comparing St. John’s wort extract to paroxetine (Paxil) showed positive results in moderate to severe depression . 

Overall, the data remains unclear whether St. John’s wort is comparable to antidepressants for severe depression.

Dosage: For mild to moderate depression, St. John’s wort is used internally in various forms.

Precautions: the use of St. John’s Wort must be supervised. Indeed, this plant interacts with many drugs and can then cause side effects. St. John’s wort is contraindicated in combination with antidepressants, especially serotonin reuptake inhibitors. St. John’s wort interacts with digoxin, theophylline, vitamin K antagonists, cyclosporine, but also oral contraceptives. 

These interactions decrease the effect of these drugs. It also interacts with certain anti-retroviral drugs used against HIV. 

Also the official recommendations are clear: “St. John’s wort is not recommended for women taking an oral contraceptive. People taking antidepressants, antiretroviral therapy should not take St. John’s wort. 

On the other hand, it is strongly advised not to combine any medication with St. John’s wort without medical advice, knowing that it can reduce the effectiveness of some of these medications. Note that this is valid for all drugs. Always avoid combining them without medical advice.

Physical activity

All health professionals agree that exercise is essential for health and therefore for mental balance. Several of the metabolic changes induced by exercise improve brain function. Endorphins, associated with the feeling of well-being, are for example released during physical activity.

Several clinical studies have looked at the positive effects of exercise in people with depression. 

A meta-analysis reveals that the effects of physical exercise in cases of depression are comparable to those of cognitive therapy, while emphasizing that the methodology of clinical trials is often open to criticism.

Most experts recommend indulging in physical activity for about 30 minutes, at least 5 days a week. The minimum amount to feel the benefits would be 3 periods of 20 minutes per week.

Fish oils (omega-3)

Epidemiological data have found an inverse link between fish and seafood consumption and depression, as well as postpartum depression. As for clinical trials, there are also encouraging data for depression, postpartum depression and bipolar disorders.

Based on these data, several researchers recommend fish oil as an adjuvant treatment for depression. In addition, a clinical study of 432 depressed Quebec and Ontario patients concluded that fish oil relieves the symptoms of depression in a manner similar to that of antidepressants, but only in people who do not suffer more than one anxiety disorder.

Dosage: The optimal dose is not established, but according to clinical trials, the dose of EPA/DHA has varied from 1 g to 4 g per day.

Light therapy

Light therapy has proven itself in the treatment of seasonal depression. With regard to non-seasonal depression, a review of studies and two meta-analyses concluded that light therapy displayed modest efficacy, in addition to conventional treatment. 

However, the authors insist on the fact that the clinical trials listed were generally of short duration and that they were carried out with few subjects.

Since then, two other clinical trials have been published. Both point to the effectiveness of light therapy in reducing symptoms of non-seasonal depression and improving overall well-being. 

During one of these trials, which lasted 5 weeks, light therapy consisted of exposure to light with an intensity of 10,000 lux every day for 30 minutes. Moreover, a clinical trial did not observe antidepressant effects superior to a placebo in a group of 81 elderly people.

SAMe

SAMe (S-Adenosyl-L-Methionine) is a molecule that plays an important role in the metabolism of hormones and neurotransmitters and participates in many biochemical reactions.

Several reviews of studies have concluded that SAMe is more effective than a placebo and as effective as tricyclic antidepressants in treating depression. It should be noted that most of the studies analyzed by the researchers had been conducted with SAMe administered in injectable form.

The results of a recent open-label study (without a placebo group) indicate that patients who did not respond well to treatment with venlafaxine, an antidepressant that is one of the selective serotonin reuptake inhibitors (SSRIs), responded well to added SAMe.

According to the most recent synthesis, with regard to oral SAMe, although preliminary results suggest that it is effective in addition to antidepressant treatment, the data remain insufficient to recommend it.

Dosage: Take 400 mg, 3 times a day.

Note: to avoid potential gastrointestinal disturbances and nausea in sensitive people, start with a dosage of 200 mg twice a day and increase gradually. Enteric-coated tablets, which are resistant to stomach acid, are also less likely to cause these types of discomfort since they are absorbed in the intestine. Although beneficial effects can be felt after only a few days, it can sometimes take up to 5 weeks before the treatment takes full effect.

Group B vitamins (including folic acid)

Deficiencies in group B vitamins, especially vitamins B6, B9 (folic acid) and B12, have been detected in depressed people in studies. Deficiencies in these vitamins can contribute to depression. 

These nutrients play an important role in the synthesis of neurotransmitters, including serotonin and dopamine. A trial conducted on 27 depressed people showed that taking 10 mg per day of folic acid in addition to 20 mg of fluoxetine (Prozac) reduced symptoms of depression more than fluoxetine alone.

At this time, doctors only recommend taking B vitamin supplements if a deficiency is suspected or detected. Many doctors, however, suggest that their patients who suffer from depression adopt a diet rich in folate (vitamin B9 from a natural source).

5-HTP (5-hydroxytryptophane)

Twenty studies have focused on the effectiveness of 5-HTP in relieving the symptoms of depression (990 subjects in all). 

Most had few participants and 11 of them did not have a placebo group. Of the 10 double-blind studies with placebo, 7 concluded that 5-HTP was superior to placebo. The data set is therefore difficult to interpret.

Dosage: Take 50mg to 100mg, 3 times a day.

Massage therapy

Positive results have been reported in studies of depression during pregnancy48 and postpartum; as well as in children and adolescents, and in patients with cancer, HIV/AIDS or kidney disease.

Many of these studies report improved mood, sleep, immune function, and reduced anxiety, stress, and fatigue, but generally do not assess the benefits over long periods of time.

A meta-analysis (including 786 patients) also concludes that massages have a positive effect on depressed people, although no specific massage protocol has been validated. 

At the same time, a review of the scientific literature reports other positive effects: stress relief (lower cortisol) and activation of the central nervous system (increase in serotonin and dopamine). Massage can therefore be considered as a complement to conventional treatments.

Yoga

An open trial conducted in 113 subjects hospitalized for psychiatric problems indicates that the practice of yoga improves mood. 

Moreover, a synthesis of 8 randomized studies aiming to evaluate the effectiveness of the practice of yoga in the treatment of depression showed that all the trials reported positive effects of yoga on the symptoms of depression, but the quality of the studies insufficient to draw a definitive conclusion. 

However, the authors believe that yoga is an effective method in addition to the traditional treatment of depression.

Dance therapy and music therapy

A randomized trial of 40 teenage girls with mild depression evaluated the effects of a 12-week dance therapy program . At the end of the experiment, the adolescent girls in the dance-therapy group showed fewer symptoms of psychological distress than those in the control group.

Moreover, an analysis of 5 randomized studies showed that music therapy improved the mood of depressed people. However, larger clinical trials are needed to accurately assess the effectiveness of these methods.

Baby massage

This approach could contribute to the well-being of the mother who experiences depression and her child.

During a clinical trial, 40 babies aged 1 month to 3 months, whose mother was depressed, were randomly subjected to 15-minute massage or rocking sessions, twice a week for 6 weeks. 

The children in the massage group gained more weight and showed a calmer temperament and better emotional and social dispositions. They seemed less stressed, cried less and fell asleep more easily.

In another randomized clinical trial, mothers with postpartum depression had better interactions with their child through massage. Their mood also improved. However, a quarter of participants dropped out of the study, suggesting that this approach may be difficult to adopt.

Ginkgo (Ginkgo biloba)

The effectiveness of this plant from the Chinese pharmacopoeia is recognized by the Commission E to relieve, among other things, the symptoms of depression experienced by certain elderly people suffering from degenerative dementia (such as Alzheimer’s disease). Ginkgo biloba may also be beneficial for older people who do not respond well to antidepressants.

Dosage: 120 mg to 240 mg of standardized extract per day (50:1), to be taken in 2 or 3 doses.

Preliminary Research on Ginkgo and Sleep Disorders

It is possible that ginkgo can also help regulate sleep in depressed people of all ages with this problem. It could therefore be considered as a complementary treatment, as suggested by a small clinical study. The ginkgo extract used, EGb Li 1370, was administered (240 mg per day) for 4 weeks, in addition to the usual medication.

Safran (Crocus sativus)

In Persian medicine, saffron is used against depression. Five preliminary trials have shown that taking 30 mg per day of saffron was more effective than a placebo in depression.

A double-blind randomized clinical trial conducted with 40 subjects even concluded that saffron was as effective as fluoxetine (Prozac) in cases of mild to moderate clinical depression. These studies were small, however, and more research is needed to confirm the effectiveness of saffron.

traditional chinese medicine

Despite the lack of research conducted on the subject, it seems that acupuncture, Chinese pharmacopoeia and Qi Gong can relieve the symptoms of depression.

A study with placebo carried out at the University of Arizona with 34 women suffering from depression revealed a reduction in symptoms of the order of 43% thanks to acupuncture (22% with the placebo). 

This is a success rate comparable to treatments with antidepressants or psychotherapy. The recurrence rate, 6 months later, also corresponds to the results of recognized treatments.

Also, the US National Institutes of Health reported that research has shown that acupuncture can alter “the chemical balance of the brain by modulating the production of neurotransmitters and neurohormones”.

However, the authors of a meta-analysis of 30 studies and more than 2,800 depressed patients believe that the data are insufficient to clearly conclude on the effectiveness of acupuncture in depression. However, two of the studies showed that acupuncture was beneficial in combination with conventional antidepressant treatment.

Image Credit: Photo by Kat Smith from pexels.com

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