Your online resource for objective Depression information

Introduction

Whether you have only recently learned that you have depression or have been living with it for years, you’ll find information on here to keep you updated with developments in the treatment field, including medical research and health news. Our ongoing dialogue with our customers enables us to keep providing you with information and support. Look out for our monthly enews (sign up here) and articles from leading experts in the field. You can find general health information on our blog where you’ll find our articles from our in-house nutritionists as well as guest practitioners, events and webinar information and our media cuttings archive.

The videos below explore depression in detail, including natural ways of overcoming it.

Recognising the causes of depressionBeating depression naturally

Symptoms

Typical symptoms may include:

  • Persistent low mood
  • Feelings of despair and hopelessness
  • Loss of interest and pleasure in activities
  • Lack of energy
  • Disrupted sleep patterns
  • Difficulty concentrating
  • Indecisiveness
  • Feelings of worthlessness
  • Anxiety, sometimes in the form of panic attacks
  • Changes in appetite, leading to weight loss or weight gain
  • Impatience, irritability
  • Loss of libido
  • Persistent, unrelenting negative thoughts
  • Suicidal thoughts

No two people suffer the same type of depression, and symptoms vary significantly in severity. The term ‘Depression’ encompasses a wide range of mood disorders and accompanying symptoms, although there are two broad types. ‘Reactive’ depression is the term attributed to an emotional state-of-being seen as a consequence of external factors, such as bereavement. ‘Clinical’ depression, on the other hand, has no known single cause, although the consensus seems to be that it is biological in origin.

Anyone can suffer from depressed feelings – indeed most of us will at various times during our lives. These episodes are usually overcome fairly straightforwardly. If an episode becomes long-lasting or periods of depression keep occurring, then it can affect an individual to the point where they become unable to look after themselves on a daily basis, and this is known as clinical depression.

According to the World Health Organisation (WHO), depression is the leading cause of disability, with between 5 and 10% of the population suffering from the illness to some extent at any one time. Research from Harvard puts the rate of increase of depression among children at a staggering 23 per cent per annum. [1] The World Health Organisation (WHO) has warned that by 2020 major depression will rank second on the list of illnesses to pose the greatest global health burden, in terms of early death, lost man-hours and use of medical resources. (heart disease is top of the list.) [2]

Within an average person’s lifetime they will have a 20% chance of having an episode of depression. The WHO have been quoted as saying that 15% of the population of most developed countries suffer severe depression. [3] Overall, depression affects about 121 million people worldwide and it is thought that about 850,000 lives every year are lost to suicide as a direct result of depression.

Whilst depression can be reliably diagnosed and treated in primary care, it is estimated that fewer than 25% of those affected have access to effective treatment. This is often due to lack of resources, lack of trained providers, but also because of the social stigma that is associated with mental disorders, meaning that people may not seek help in the first place.

[1] Harvard University study reported in Harvard Mental Health Newsletter, February 2002.
[2] World Health Organization (WHO) report on mental illness, 4th October 2001.
[3] World Health Organization (WHO) report quoted on BBC Online, 9th January 2001. Available: http://news.bbc.co.uk/1/hi/health/1108793.stm.

Causes

Whilst the causes of depression are still poorly understood, it is thought to occur as a result of physical, psychological and environmental factors. The chemical neurotransmitters serotonin, noradrenalin and dopamine are all important in regulating many functions in the brain, including our mood. Depression can occur as a direct result of a chemical imbalance in one or more of these substances in the brain.

Stress also plays a part in the onset of depression. The ‘fight or flight’ response is the body’s primitive and automatic response that prepares the body to ‘fight’ or ‘run’ from perceived attack or, in other words, our biological response to acute stress. During a stressful experience, there is a complex set of interactions between the hypothalamus (a part of the brain), the pituitary gland (also part of the brain) and the adrenal glands (at the top of each kidney). Several types of neurotransmitters are involved in this system, collectively known as the HPA-axis. Continued stress, however, can cause overactivity of the HPA-axis and result in an imbalance of neurotransmitters. It is thought that it is this imbalance which plays a pivotal role in the development of depressive symptoms.

As with many conditions and diseases, changes in any of the genes involved in a neurotransmitter pathway or those genes that are responsible for controlling neurotransmitter production can also influence the risk of depression. If there is familial history of depressive illness (genetic susceptibility), this increases the chance of an individual experiencing depression themselves.

Fatty acids

Long-chain omega-3 fatty acid deficiency is a common feature associated with depression. Over 30 peer-reviewed papers have been published over the last decade, suggesting that increasing omega-3 levels and restoring the body’s natural omega-6 to omega-3 ratio has significant health benefits, and major benefits for depression sufferers. The ratio of EPA to DHA within fish oil is of significance when establishing the efficacy of a supplement in the treatment of depression; the higher the EPA to DHA content, the greater the efficacy; EPA has to be in excess of DHA to show benefits. Therefore oils containing DHA may not be suitable for the treatment of depression and may explain the lack of efficacy with the use of generic fish oils.

The ethyl-EPA in Pharmepa STEP 1: RESTORE is prescription-strength and especially concentrated, with DHA removed to ensure optimal efficacy. Ethyl-EPA has been shown to offer effective support for mood balance, stress relief and the regulation of inflammatory products, balancing the mood-regulating neurotransmitters tryptophan and serotonin. Taken at a dosage of 1 gram daily for three months and as effective as antidepressants in its actions, ethyl-EPA is becoming recognised as a safe, convenient treatment for depression and without the negative side effects associated with conventional medication.

Recommendation

With its high EPA content we recommend Pharmepa STEP 1: RESTORE at 1-2 capsules daily, because it’s suitable for counteracting omega-3 deficiencies and restoring a healthy omega-6 to omega-3 ratio. For those individuals with a sub-optimal AA:EPA ratio and low omega-3 index, high dose E-EPA is not only beneficial for increasing omega-3 levels and raising the omega-3 index, but is particularly effective in restoring the AA:EPA ratio, with favourable outcomes on long-term health. Once an optimal AA:EPA ratio and omega-3 index is achieved, switching to Pharmepa STEP 2: RESTORE can provide the key ingredients for the long-term maintenance of healthy omega-3 and omega-6 levels. For children we recommend Vegepa E-EPA 70 Chewables. Adults and children aged eight years and over should take 4-6 capsules daily. For vegetarians, our Echiomega supplement provides a more effective solution than flaxseed oil, with higher conversion to the important long-chain fatty acid EPA. Adults and children aged twelve years and over should take between 2 and 4 capsules daily.

References

Conklin SM, Runyan CA, Leonard S, Reddy RD, Muldoon MF & Yao JK. (2010) Age-related changes of n-3 and n-6 polyunsaturated fatty acids in the anterior cingulate cortex of individuals with major depressive disorder. Prostaglandins Leukotrienes and Essential Fatty Acids 82:111-9.

Frangou S, Lewis M, & McCrone P. (2006) Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomised double-blind placebo-controlled study.  British Journal of Psychiatry 188: 46-50.

Hibbeln JR. (1998). Fish consumption and major depression. Lancet 351: 1213.

Horrobin DF. (2001) Phospholipid metabolism and depression: the possible roles of phospholipase A2 and coenzyme A-independent transacylase. Human Psychopharmacology 16:45-52  

Jazayeri S, Keshavarz SA, Tehrani-Doost M, Djalali M, Hosseini M, Amini H, Chamari M & Djazayery A. (2010) Effects of eicosapentaenoic acid and fluoxetine on plasma cortisol, serum interleukin-1beta and interleukin-6 concentrations in patients with major depressive disorder. Psychiatry Research 178:112-5. 

Jazayeri S, Tehrani-Doost M, Keshavarz SA, Hosseini M, Djazayery A, Amini H, Jalali M & Peet M. (2008) Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder. Australian and New Zealand Journal of Psychiatry 42:192-8.

Martins JG. (2009)  EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomised controlled trials. Journal of the American College of Nutrition 28:525-42. Review.

Martins JG, Bentsen H & Puri BK. (2012) Eicosapentaenoic acid appears to be the key omega-3 fatty acid component associated with efficacy in major depressive disorder: a critique of Bloch and Hannestad and updated meta-analysis. Molecular Psychiatry [Epub ahead of print]

McNamara RK. (2011) Long-Chain Omega-3 Fatty Acid Deficiency in Mood Disorders: Rationale for Treatment and Prevention. Current Drug Discovery Technologies [Epub ahead of print]

Peet M & Horrobin DF. (2002) A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Archives of General Psychiatry 59: 913-919.

Puri BK & Boyd H. (2004) The Natural Way to Beat Depression: The Groundbreaking Discovery of EPA to Change Your Life. Hodder Mobius: London.

Puri BK, Counsell SJ, Hamilton G, Richardson AJ & Horrobin DF. (2001). Eicosapentaenoic acid in treatment-resistant depression associated with symptom remission, structural brain changes and reduced neuronal phospholipid turnover. International Journal of Clinical Practice 55: 560-563.

Puri BK, Counsell SJ, Richardson AJ & Horrobin DF. (2002). Eicosapentaenoic acid in treatment-resistant depression. Archives of General Psychiatry 59: 91-92.

Sublette ME, Ellis SP, Geant AL & Mann JJ. (2011) Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression. Journal of Clinical Psychiatry 72:1577-84.

Tanskanen A, Hibbeln JR, Tuomilehto J, Uutela A, Haukkala A, Viinamaki H, Lehtonen J & Vartiainen E. (2001) Fish consumption and depressive symptoms in the general population in Finland. Psychiatric Services 52:529-31