The Season is the Reason: Depression

By: Dr. Deedra Mason 

It’s that time of year, no not the crazy holidays, but the time of year where the hours of daylight are short, the weather is colder and it is seemingly harder for most to get outside for their daily dose of exercise and sunshine. Is this the reason for those “holiday blues?”

The numbers are in:

A study by the World Health Organization (WHO) in October 2017 reported the economic hardship of such mental emotional complaints cost close to 1 Trillion dollars globally in lack of workplace productivity.  The WHO also looked at how this breaks down by the concern.

According to the WHO, 1 in 5 of adults report a new or additional mental complaint in a given year, for 1 in 25, this complaint is a serious progression of their disease. (1)  Roughly 42 million Americans report anxiety, which is 18 % of the adult US population.  Another 16 million people have been diagnosed with severe depression. That is 7% of American adults.  We, as a population, are starting to see this creep into adolescents and teens with depression being of significant concern as suicide is the second leading cause of death in those between the ages of 15 and 19 years of age (2).

It is important to note that mental health concerns have many different presentations through the ages. As such, there is a multitude of interventions including nutritional, botanical, and lifestyle.  Access to this information and these interventions as well as community and health resources is paramount to managing these mental health concerns.

 

One approach to caring for the body, mind, and spirit is to copy nature. 

Natural therapy, often referred to as alternative therapy, utilizes a diverse combination of vitamins, botanical, and amino acids.  Vitamins such as a complex of vitamin B’s, vitamin C, omega three fatty acids, and minerals such as magnesium are natural building blocks for the neurotransmitters Serotonin, Dopamine, Norepinephrine, and GABA.  Furthermore the combination of amino acids like tyrosine, phenylalanine and glycine, for example are “the backbone” same neurotransmitters.  An individual’s relative access to these natural building blocks may be limited when you consider the increased physical and mental demands of our jobs, social life, and family life.  Often these three parts of our lives are at odds with each other, yet each is so necessary to complete us as social and tribal beings.  Sugar over-load and lack of quality sleep are also thieves of your neurotransmitters and may add significantly to your relative risk.

 

Here is a test to find out if one of these is putting you at risk:

Calculate how many hours a day you spend on a tablet or smartphone?  As that number goes up, studies show that your risk for depression and anxiety rise with it. In addition to increasing your risk, these same devices are understood to steal hours away from quality sleep and interpersonal interactions as well. (3)

If after seeing the link between your phone or tablet, lower quality sleep and depression you asking the question, “what can I do…today?” then you may be pleased to know natural therapies have shown considerable success in supporting people with a spectrum of anxiety presentations.  Naturally-derived ingredients like L-tryptophan, Quatrafolic, B-6, as well as the amino acid tyrosine, are used more and more as a conventional approach to this new age problem. These substances have decades of research to determine their efficacy and safety as an option for regular care and support.

 

The Serotonin Pathway:

The serotonin pathway is considered the gateway to the spectrum of mental health concerns people face on a daily basis.  Even the mildest of stressors can influence the production and adequacy of this neurotransmitter.  The precursor to its creation is the essential amino acid, Tryptophan. Tryptophan can be found in beef, poultry, and fish, as well as nuts, seeds, and legumes. The advantage to dietary sources of tryptophan is that these sources are naturally rich in other building blocks like Vitamin C, B-6, and magnesium.

Serotonin levels in the brain are strongly dependent on access to transport molecules to enter the central nervous system.  Both B-6 and curcuminoids have been clinically shown to enhance first availability of L-tryptophan with B-6’s help and crossing the blood-brain barrier with a curcuminoid’s help. (5) When these other natural ingredients are present, other neurotransmitters are likely to increase because curcumin’s activity can free up transport molecules for complimentary neurotransmitters like dopamine and norepinephrine and ultimately GABA.

 

Is there more to the story?

Vitamin D3 -The Sun “Vitamin”

Vitamin D3, as you know, plays an important role in bone health, heart health and immune support. Surprising to many however was learning this multitasking vitamin might also help combat anxiety and depression.

An analysis of Internet searches on “depression” over the period 2004-2009 found wintertime peaks for depression and anxiety in 54 geographical locations in Australia and the United States.(5) This gives credence to the sunlight and seasonal factors for mental-emotional health concerns.  Vitamin D levels are lowest in winter, which may help to explain many of the findings.

The estimated recommended minimum daily dosage of vitamin D for those aged 1 – 50 is 600IU or 15mcg daily. However, higher levels of 2000 IU/d for children 0–1 year, 4000 IU/d for children 1–18 years, and 10,000 IU/d for children and adults 19 years and older may be needed to correct vitamin D deficiency. (6)

The amount of research about vitamin D and depression, as well as other mental health problems, is growing. In a review of the research about vitamin D and depression in 2013 (7), researchers analyzed all of the published research about depression and vitamin D leading up to February 2011. They included the high-quality research studies that explored whether:

  • A lack of vitamin D in the blood is linked with being depressed
  • The lack of vitamin D in the blood makes it more likely an individual will develop depression
  • Taking a vitamin D supplement can improve or prevent depression

The researchers found more than 5000 research articles; however, just 13 explored this area effectively. With greater than 31,000 participants over 13 studies, the anlysis showed a relationship between low levels of vitamin D in the blood and depression. A 2008 research study from Norway (8) found people with a low level of vitamin D in their blood had more symptoms of depression. This research also found that taking vitamin D, particularly in large amounts, greater than 4000 iu’s per day improved the symptoms of depression. Those noticing the greatest benefit were those with more severe symptoms.

A study of young adults in New Zealand found that there was a modestly higher depression score for those with lower vitamin D levels. (9) There was no difference in the time spent outdoors between those with a lower or higher depression score.

A study in Sweden found that those who attempted suicide had significantly lower vitamin D levels than non-suicidal depressed patients or healthy controls.(10) They also had higher concentrations of pro-inflammatory cytokines, which have been observed in other suicidal patients. Cytokines are small proteins emitted by cells to signal other cells. Vitamin D is known to reduce the levels of pro-inflammatory cytokines.

A 20-year study in Iowa found that for people with major depressive disorder, there was a slight increase in depressive symptoms in the winter months, peaking in March. However, new episodes were highest from October through January, peaking in January. (11)

Exactly how vitamin D works in the brain is not fully understood. One theory points to the fact that vitamin D receptors are found in many parts of the brain that are linked to the development of depression. This could indicate that vitamin D may affect the amount of serotonin, a type of monoamine, and how it works in the brain.(12)  Many anti-depressant medications work by increasing the amount of monoamines in the brain. Therefore, researchers have suggested that vitamin D may also increase the amount of monoamines, which may help treat depression. (13)

 

What does this mean for me?

Research has not yet clearly shown whether low levels of vitamin D cause depression, or whether depression causes low levels of vitamin D. This means that we don’t know whether an increase of this vitamin will help to prevent or ease the symptoms of depression. Depression has many causes, but it looks as if vitamin D deficiency may be a contributor.

If you have depression and want to take vitamin D, it is unlikely to make your symptoms worse or cause you any harm (as long as you are taking less than 10,000 IU/day). However, if you have depression you should not take vitamin D in place of other treatments or anti-depressant medicines. Speak to your physician for more advice about treatments and taking supplements.

Keep steady in knowing there are a variety of nutritional methods clinically supported to help you, whatever you and your practitioner decide.

 

 

Resources:

(1) WHO’s Mental Health Gap Action Programme (mhGAP)- Mental Health Fact Sheet 2017

(2) Department of Maternal, Newborn, Child and Adolescent Health (MCA); Adolescents and mental health 4, 2017

(3) Matar Boumosleh J, Jaalouk D (2017) Depression, anxiety, and smartphone addiction in university students- A cross sectional study. PLoS ONE 12(8)

(4) 5. Den Boer JA, Westenberg HG. Behavioral, neuroendocrine, and biochemical effects of 5-hydroxytryptophan administration in panic disorders. Psychiatry Res. 1990;31(3):267-278.

(5) Yang AC, Huang NE, Peng CK, Tsai SJ. Do seasons have an influence on the incidence of depression? The use of an internet search engine query data as a proxy of human affect. PLoS One. 2010;5(10):e13728.

(6) Swiglo BA , Murad MH , Schünemann HJ , Kunz R , Vigersky RA , Guyatt GH , Montori VM 2008 A case for clarity, consistency, and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system. J Clin Endocrinol Metab  93:666–673

(7) Anglin, R.E., Samaan, Z., Walter, S.Det al., Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry, 2013. 202: p. 100-7.

(8) Jorde, R., Sneve, M., Figenschau, Y, et al., Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial. J Intern Med, 2008. 264(6): p. 599-609.

(9) Polak, M.A., Houghton, L.A., Reeder, A.I., et al., Serum 25-hydroxyvitamin D concentrations and depressive symptoms among young adult men and women. Nutrients, 2014. 6(11): p. 4720-30.

(10) Grudet, C., Malm, J., Westrin, A., et al., Suicidal patients are deficient in vitamin D, associated with a pro-inflammatory status in the blood. Psychoneuroendocrinology, 2014. 50: p. 210-9.

(11) Cobb BS, Coryell WH, Cavanaugh J, et al. Seasonal variation of depressive symptoms in unipolar major depressive disorder. Compr Psychiatry. 2014;55(8):1891-9.

(12)  Eyles, D.W., Smith, S., Kinobe, R., et al., Distribution of the vitamin D receptor and 1 alpha-hydroxylase in human brain. J Chem Neuroanat, 2005. 29(1): p. 21-30.

(13) Kjaergaard, M., Waterloo, K., Wang, C.E, et al., Effect of vitamin D supplement on depression scores in people with low levels of serum 25-hydroxyvitamin D: nested case-control study and randomised clinical trial. Br J Psychiatry, 2012. 201(5): p. 360-8.