Teenage Depression / Tackling Depression — (Hinduism Today)

SSRI Ed note: Indian physician explains why he recommends against prescribing antidepressants to young people.

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Hinduism Today (July, Aug, Sept 2007 Issue)

Beware the causes and the drawbacks of standard treatments for this unfortunately common ailment

by Dr. Virender Sodhi

Four out of 100 teenagers become seriously depressed each year. Everybody feels sad now and then; but if they’re sad most of the time, and it’s causing problems in school and with relationships with family and friends, they may be clinically depressed.

What is depression?

Clinical depression is a serious illness that can affect anybody, including teenagers. It can affect their thoughts, feelings, behavior and overall health. Common symptoms are poor appetite, insomnia or excessive sleep habits, hyperactivity or inactivity, loss of interest or pleasure in usual activities, fatigue, feelings of worthlessness or self-reproach, diminished ability to think or concentrate, and recurrent thoughts of death or suicide. Intense bouts of depression that last for weeks at a time are called major depression. A less severe form can linger at a low level for years. A third form is a depressive reaction to a specific life event, such as a death, divorce or other loss, when the adjustment to the loss takes longer than normal or is more severe than expected and interferes with the person’s daily activities. And there is another condition, bipolar disorder (also called manic depressive illness), in which periods of major depression alternate with periods of abnormally high mood and extreme bursts of unusual activity, called mania. What causes depression? Depression can be the result of psychological as well as physiological factors. The predominant psychological theory asserts that depression is the result of habitual feelings of pessimism and hopelessness.

The chief physiological theory points to imbalances of monoamine neurotransmitters such as serotonin, epinephrine, and norepinephrine. Serotonin deficiency is the most common biochemical cause. It is important to screen for the various simple, organic factors which are known to contribute to depression. These include nutrient deficiency, hypoglycemia (low blood sugar), hypothyroidism (low thyroid function) and drugs–not only prescription and illicit drugs, but also alcohol, caffeine, nicotine, etc. Although it is uncommon to perform lab tests in the diagnosis of depression, I run a thorough blood and urine test for these factors to determine if any of them is causing a chemical imbalance. The brain requires a constant supply of blood sugar to function properly, so hypoglycemia must be avoided. Symptoms of hypoglycemia can range from mild to severe and can include depression, anxiety, irritability, fatigue, headache, blurred vision, mental confusion, incoherent speech and convulsions. Several studies have shown that hypoglycemia is common in depressed individuals. Simply eliminating from the diet refined carbohydrates and caffeine, which can aggravate hypoglycemia, is sometimes sufficient treatment for those whose depression results from hypoglycemia.

Food allergy is a causative factor in other cases of depression. Eliminating offending foods can bring about tremendous relief. A deficiency of any single nutrient can alter brain function and lead to depression, anxiety and other mental disorders. Particularly essential in this context are vitamin B12, folic acid and other B vitamins, and the omega-3 fatty acids. What are the standard treatments for depression? Most people are treated with counseling, or psychotherapy, which is talking about feelings with a trained psychologist who can help one change the relationships, thoughts or behaviors that are causing the depression. Your child may feel depressed because she thinks her life is bad. What if she is wrong? What if her future holds a lot more promise than she thinks? When someone is depressed, they are in a rut, and they can’t see anything positive. They need to talk to someone who can help them get out of that rut. Young people should seek help from parents or their school counselor. Parents need to take a very active role by first recognizing that their child is depressed and then providing all the help they can. Some people are helped with counseling and medicine.

Doctors routinely prescribe a number of different antidepressant medications. These differ in their side effects and levels of effectiveness. The most common drugs prescribed today for depression are the selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil) and sertraline (Zoloft). Other similar drugs are venlafaxine (Effexor), nefazodone (Serzone), clomipramine (Anafranil) and bupropion (Wellbutrin). All of these drugs correct decreased levels of specific neurotransmitters in the blood that can cause or contribute to depression. Do these drugs pose risks to children and teens? In 2003 the British Medicines and Healthcare Regulatory Agency banned the pediatric use of all SSRIs except Prozac due to evidence from clinical trials showing that children taking SSRIs were driven to acute emotional distress, leading some of them to become suicidal and homicidal. In December, 2003, after reviewing 22 clinical trials showing that children using nine SSRIs were on average almost twice as likely to become suicidal, senior US Food and Drug Administration epidemiologist Dr. Andrew D. Mosholder recommended a ban on pediatric use of the drugs. The FDA barred him from presenting his conclusions publicly and commissioned researchers at Columbia University to re-examine the data. Their findings were virtually the same. In September, 2004, the FDA released a long-awaited analysis concluding that young patients taking antidepressants could be at increased risk for self-harm. They directed manufacturers to add black-box warnings (the most serious kind of warning) on doctor labeling to describe the increased risk of suicidality in young people being treated with antidepressants. The label wording includes a reminder that Prozac is currently the only medication approved to treat depression in children and adolescents. The FDA also planned to develop a patient medication guide to be given along with prescriptions. Although increased risk of suicidal behavior in youth may be the worst side effect of antidepressant drugs, there are many others. In my article in the coming October/November/December, 2007, issue of Hinduism Today I will offer natural remedies from the ayurveda tradition that I have found to be effective in the treatment of depression.

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Hinduism Today (October/November/December 2007 Issue)

Ayurvedic remedies raise spirits as effectively as drug treatments, without troublesome side effects

Dr. Virender Sodhi

In my article in the July/August/September issue I wrote about clinical depression in young people and the treatments that are standard in Western medicine, including antidepressant drugs known as selective serotonin reuptake inhibitors, or SSRIs. All of these drugs are known to have unpleasant and potentially dangerous side effects, including nausea, headache, clenching of teeth, strange dreams, dizziness, weight loss/gain, increased feelings of depression and anxiety, tremors, restlessness, liver or kidney impairment, and a loss of sense of reality. Based on studies, regulatory agencies decided in the last few years that it was prudent to inform patients of the most dangerous side effect of them all: increased thoughts of suicide and suicidal behavior. On the other hand, recent reports purport a relationship between a subsequent decrease in pediatric SSRI prescriptions and an increase in adolescent suicide. In my opinion, there is no sense risking that your child will become suicidal from taking antidepressants when there are natural remedies for depression that have proven to be both effective and totally safe. For example, along with counseling, supplements of 5-Hydroxytryptophan, St. John’s wort extract, ashwagandha, Bacopa monnieri and Mucuna pruriens have all been effective in my clinical experience. The chemical 5-Hydroxytryptophan (5-HTP) is extracted from the seed of an African plant (Griffonia simplicifolia) and is the direct precursor to serotonin. In addition to increasing serotonin levels (which correspond to feelings of well being), 5-HTP causes an increase in levels of endorphin and other neurotransmitters. Numerous double-blind studies have shown that it has effectiveness equal to the SSRIs, and it offers several advantages: it is less expensive, better tolerated and associated with fewer and much milder side effects. The typical recommendation is 50 to 100 mg three times daily. St. John’s wort extract (Hypericum perforatum) is a well-known natural antidepressant. Over thirty double-blind studies involving over 2,000 patients with mild to moderate depression have shown St. John’s wort extract to be effective. However, while it appears to be as, or possibly more, effective than conventional antidepressant drugs in mild to moderate depression, it does not appear to be as beneficial in the treatment of severe depression. St. John’s wort extract’s advantages over pharmaceutical drugs include far fewer side effects, lower cost and greater patient satisfaction. The dosage for St. John’s wort extract (standardized for hypericin and hyperforin content) is 900 to 1,800 mg daily.

In severe cases, St. John’s wort extract can be used safely in combination with 5-HTP. People taking prescription drugs need to check with their doctor or pharmacist before taking St. John’s wort extract, as it appears to induce enzymes in the liver and gut that detoxify certain drugs. St. John’s wort extract may also potentiate prescription antidepressant and anti-anxiety drugs. While I am of the opinion that St John’s wort and 5-HTP can be combined with low doses of anti-depressant medications, I strongly advise it only be done under the strict supervision of a physician. Ashwagandha (Withania somnifera), standardized for withanoloids, has shown to be effective in the treatment of anxiety and depression in several studies alongside pharmaceutical antidepressants. I recommend 1,000-1,500 mg three times a day. Ashwagandha is a wonderful adaptogen, increasing the body’s resistance to stress, trauma, anxiety and fatigue, and has many other positive health benefits. Bacopa monnieri, another brain tonic herb, has also shown antidepressant and anti-anxiety effects. Both of these herbs can, however, increase the effects of benzodiazepines and phenobarbiturates. Mucuna pruriens, another herb, has been shown to increase dopamine in the body, therefore it is effective in cases of low dopamine levels. I recommend 250 mg three times per day. The primary advantage of these natural extracts and herbs over the chemical antidepressants is that they have minimal or no side effects, yet offer excellent results. Studies looking at exercise, yoga, pranayama and meditation have shown positive outcome in almost all diseases, but especially anxiety, post traumatic stress disorder, depression, stress-related medical illnesses and substance abuse. I recommend fast walking at least 45 minutes and yoga and pranayama for 30 minutes every day. Alternate nostril breathing, anulom-vilom, and fire breath, kapal batti, are of great benefit in lowering depression and anxiety. There are many forms of meditation, among them quieting the mind, reciting a mantra, getting rid of all thoughts, guided imagery and holding attention focused. All forms have shown remarkable results. Keep in mind that it may take four to six weeks before you start feeling the difference when using a combination of herbal and nutritional therapies with exercise, yoga, pranayama and meditation. But this is the same expected time frame as in standard drug treatments. Clearly, modern drug therapy may be dangerously unsafe for teens with depression. It is important when seeking help for your son or daughter to work with health practitioners who are open to the various options and are willing to work with alternative practitioners.

No matter what approach is used, a seriously depressed person should always be under the supervision of a psychiatrist, working together with complementary practitioners. Let me end with some testimony about the effectiveness of natural remedies for depression. A 24-year-old boy from Alberta, Canada, who has been on antidepressants for one year, came to my clinic near Seattle. He was put on a nutritional program along with St. John’s wort, ashwagandha and Bacopa, plus exercise, yoga, meditation and pranayama. Three months later, after consulting his psychiatrist, I learned he was off antidepressants and feeling back to normal again. On a personal note, last year my sixteen-year-old son, Rishi, died tragically. My wife, Rekha, our twenty-year-old son, Gunny, and I all went into deep depression. Following a dietary, herbal and physical regimen, we have been able to cope. Gunny was the hardest hit of all. It was a rough year, but finally he turned around, all without any chemical medications.

Dr. Virender Sodhi holds an M.D. (Ayurveda) from India and a N.D. from Bastyr College of Naturopathic Medicine, USA. E-mail: drsodhi@ayurvedicscience.com. Web: http:/www.ayurvedicscience.com.