DEPRESSION is one of the most common mood disorders, affecting nearly everyone either through personal experience or through a loved one. The cost in human suffering is enormous and cannot be estimated as the disorder interferes with normal functioning by disrupting the lives of families and friends, causing tremendous emotional pain and reducing work productivity. Serious depression destroys life.

A diet rich in fruits and vegetables is recommended for people with depression.

Although common, depression is underdiagnosed. Many depressed persons do not get proper treatment because their symptoms are not recognised as depression. Many of the symptoms such as sleep and appetite disturbances, mimic physical illness. In addition social stigma causes people to avoid needed treatment, individual symptoms are treated rather than the underlying cause, and depressed people are seen as weak or lazy. With proper treatment, nearly 80 per cent of those with depression can make significant improvement in their mood and life adjustment. Recognising depression is the first step in treating it.

Depression can directly and indirectly contribute to chronic medical conditions, such as heart disease and stroke. This occurs because depressed people with these conditions are less likely to engage in healthy lifestyle behaviours and more likely to engage in unhealthy behaviours (such as smoking and excessive alcohol drinking). Suicide is a significant factor in depression; about 15 per cent of people with major depressive disorder commit suicide. Depression also significantly shortens the lifespan of the elderly and is associated with the development of memory impairment and dementia.

There are several treatment options available for people with depression and the prognosis improves tremendously for those who seek treatment and comply with their regimen.

Treatment

Psychotherapy
Psychotherapy assists the depressed individual in several ways. First, supportive counselling helps ease the pain of depression, and addresses the feelings of hopelessness that accompany depression. Second, cognitive therapy changes the pessimistic ideas, unrealistic expectations and critical self-evaluations that are associated with and sustain depression.

It also helps the depressed individual to develop positive life goals. This therapy is frequently considered the treatment of choice for people with mild to moderate depression. Third, problem-solving therapy changes the areas of the person's life that are creating significant stress and contributing to the depression. Behavioural therapy to develop better coping skills or interpersonal therapy, to assist in solving relationship problems may be required.

Meditation Although meditation is not a cure-all, it has applicability to those who suffer from depression since it is connected with learning to move from an undesired state of depression to desired states that are more pleasant and fulfilling and allow for normal functioning.

Light therapy has been used for seasonal affective disorder. Symptoms of depression can be alleviated by exposure to sunlight. Acupuncture, massage therapy, aromatherapy and relaxation therapies (yoga and tai chi) are also very useful.

Lifestyle Changes

Exercise
Regular exercise (either aerobic or strength/flexibility training) significantly reduces depressive symptoms in people with mild to moderate depression and improves the mood of people with major depression.

Nutrition and Dietary Supplements
Scientific study and clinical experience show that several natural remedies can alleviate depression. A diet rich in fruits and vegetables, particularly leafy green vegetables, is recommended for people with depression. Supplementation with a multivitamin is also recommended.

Folate Studies suggest that folate may be associated with depression more than any other nutrient. Between 15 per cent and 38 per cent of people with depression have low folate levels in their bodies and those with very low levels tend to be the most depressed.

Omega-3 fatty acids
Essential fatty acids, such as omega-3 and omega-6 fatty acids, play a crucial role in the function of brain chemicals, particularly serotonin and dopamine. It has been demonstrated that low levels of omega-3 fatty acids (found in fatty fish such as mackerel, sardines and salmon), or a high ratio of omega-6 fatty acids (found in cereals, baked goods, vegetable oils) to omega-3 fatty acids, may be associated with depression.

A typical Western diet is high in omega-6 compared to omega-3 fatty acids. Eating foods rich in omega-3 fatty acids on a regular basis helps maintain an appropriate balance of omega-6 to omega-3 fatty acids; restoring this balance may help with feelings and symptoms of depression. Dietary supplementation with omega-3 fatty acids may help prevent depression.

S-Adenosinemethionine (SAMe)
Some studies suggest that the dietary supplement SAMe may be just as effective as tricyclic antidepressants for treating depression, but with fewer side effects. SAMe appears to boost serotonin levels in the brain.

Tryptophan
Tryptophan is an amino acid involved in the production of serotonin. Studies suggest that tryptophan depletion can lead to diminished serotonin levels, and in some cases, may increase a person's susceptibility to depression.

Selenium
It has been reported that the mineral selenium (found in wheat germ, brewer's yeast, liver, fish, shellfish, garlic, sunflower seeds, Brazil nuts, and grains) significantly affects mood. In one study of people with low levels of selenium, those who consumed a diet high in selenium reported decreased feelings of depression after five weeks.

Herbs
St John's wort (Hypericum perforatum). In Germany, hypericum accounts for more than 50 per cent of the antidepressant market. Prozac has two per cent. There is scientific evidence that St John's wort is useful for treating mild to moderate depression. Damiana, Panax ginseng and Valerian root are useful in treating depression.

Medications
Except in the more severe depressions and bipolar depression, medication is usually not necessary. Antidepressant medication does not cure depression, it helps by controlling certain symptoms.

These symptoms (sleep and appetite disturbances, significant concentration problems, and chronic fatigue) interfere with the ability to make the life changes necessary to eliminate the depression. In more serious depression, suicidal thoughts and preoccupation with death may require medication in addition to psychotherapy. Antidepressant medication can help relieve those symptoms, and facilitate needed life changes.

Preventive care is important. Depression can be prevented and the chances of relapse decreased by the following :
. Adequate sleep, regular exercise, and a balanced, healthy diet.
. Mind/body techniques, such as biofeedback, meditation, and tai chi.
. Psychotherapy directed at coping skills generally helps prevent relapse.
. Family therapy may prevent children or teens of depressed parents from becoming depressed later in life.
. Compliance with the prescribed treatment regimen.
I wish you a happy, peaceful and prosperous New Year.

Dr Jacqueline E Campbell is a family physician in private practice. E mail: drjcampbell14@yahoo.com.

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