The National Institute of Mental Health (NIMH) estimates that 16.2 million U.S. adults had at least one major depressive episode in 2016. One can only imagine that this has increased exponentially in the last few years, as we’ve faced some of the biggest challenges to date, such as a global pandemic. I’d go so far as to say that this depression is an epidemic, which is why it’s so important to face it head-on and not look the other way due to the stigma that tends to surround mental health issues. If you are depressed or suspect you might have depression, all is not lost. Below, we explore what causes depression and some ways you can get help to counteract its symptoms to manage it or hopefully be cured altogether. 

What is depression?

We’ve all seen the commercials with a depressed person lying on the couch, having their dog drop the ball at their feet. The clear implication is that this person is too depressed to do even the most basic things, like playing with or exercising with their dog. And while depression can most certainly look like this, it can look like many other things, too. So what is depression?

The American Psychiatric Association defines depression as the following:

“Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think, and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and home.”

I look at depression as a medical condition that’s a complicated cluster of symptoms that can range significantly from person to person depending on age groups, gender, and cultural expressions. This variation can make it challenging to diagnose and treat, but there are some typical clusters of symptoms that we look at even across cultures.

The symptoms of depression we most often see are:

• Not having much pleasure - little interest in doing things that you usually would have done, which is sort of the hallmark of depression

• Being more emotional - feeling down and hopeless

• Sleeping more or hypersomnia - bad or low energy

• Appetite changes - overeating or stopping having the desire to eat

• Feeling like you’re a burden on people

• Trouble concentrating, so you can’t read or stay in conversations, and this can manifest as being scattered

• Things seem to move way too fast, so you feel slow to respond to things

• Some people feel fidgety and uncomfortable in their bodies, which can contribute to insomnia

On the more serious side, some depressed people have suicidal ideation. And then we have to ask—are they thinking about the act of committing suicide, or are they thinking about not wanting to be here anymore? There’s a very fine line between these two things, and it gets far more serious when the depressed person has a plan to carry out the suicide. Some people feel that life is simply too miserable and wish things like the world would end. Sometimes it’s not even about death, but then, alternatively, the person can become obsessed with it. They think about it so much that they will even dream about it. Again, there is so much variation from person to person, but if you have any suicidal ideation at all, you definitely need to talk to your doctor.

Sometimes suicide goes against someone’s religion or culture, and it’s time that we acknowledge that there’s a lot of stigma around mental health and getting help for these issues. Some people tell themselves to “just pull yourself together.” I’m here to tell you that this kind of thinking will never work, as depression is rooted in biology. We don’t want or need to belittle ourselves for having a health condition. 

What Are the Causes of Depression?

Several things can cause depression. The current understanding is that there is an imbalance in neurotransmitters in the brain. These centers in the brain can become more hyperactive while some get more suppressed. There are also some more recent theories about inflammation in the brain. The brain can’t resolve this, so it changes its biochemistry. 

I believe that because the brain is connected to the body, you experience many physical symptoms when you have depression.

Some of the physical symptoms you can experience when you have depression are:

• GI symptoms like nausea

• Body aches

• Headaches

• Muscle tension

• Stiffness

Again, there are some cultural differences in these symptoms and even some variations between genders. 

Some causes of depression are as follows:

• Aging - our brains change, and everything’s slowing down, and there’s a higher risk of depression 

• Social isolation, such as in the senior community or in those who have experienced loss

• Abuse and trauma - these shape the way the brain forms in earlier years, and they increase your risk for depression 

• Physical illnesses such as cancer and heart disease 

• Physical, emotional, sexual abuse, or even traumatic brain injuries can put you at risk earlier or later in life

• Stress due to finances and other situations - this taxes the body and brain  

• Hormones 

• Significant changes - new jobs, moving, new relationships, and loss of relationships can all trigger those changes in the body and the brain

• Major world events such as 9/11 and the current pandemic

Grief can be another cause of depression that can be more complicated than the others.  When you’re grieving, sadness is entirely normal and even expected. The thing to be aware of is that grief can exacerbate depression or become a risk factor for experiencing depression, which we refer to as “complicated grief.”

Women are more likely to get depression than men. We’re not sure why but we think it’s due to hormones such as in perimenopause or changes in hormones. There’s also a cultural component in that women are freer to talk about emotions, especially in areas where there are strict gender roles. Women can be emotional, but men are supposed to be strong. These notions can inhibit men from accessing those feelings or having conversations about their physical bodies or anxiety and depression.

Genetics can also certainly be a factor. Psychiatric predispositions to diseases like Huntington’s, CF, and Alzheimer’s can cause depression, which is unfolding and emerging as we continue to study this complicated disease. Remember, though; you’re not a prisoner to your genes—you can do things to mitigate risks and lessen the effects of the symptoms of depression.

Unfortunately, people in my field and other doctors often see an uptick in substance abuse during challenging times. Then this substance abuse can put you at risk for depression and anxiety. I never judge people for their use or abuse but instead use this information to find out why they reach for substances. This clues me in to whether the root cause is actually a mental health issue rather than an addiction issue.

As the National Center For Biotechnology Information (NCBI) points out, improvements in acute care over the past several years have resulted in higher survival rates for those with traumatic brain injuries. “Unfortunately, the majority of survivors of moderate and severe TBI have chronic neurobehavioral sequelae, including cognitive deficits, changes in personality and increased rates of psychiatric illness.”

How We Can Treat Depression

Fortunately, there are many ways to treat depression, and we explore that below.

Talk Therapy

Talk therapy is a wonderful option for those who suffer from depression. Although many forms of talk therapy can be beneficial, there is some excellent evidence that cognitive-behavioral therapy (CBT) is a leader in this area. It’s straightforward, insightful, and helps you understand how negative core beliefs influence your brain’s chemistry. Even better, CBT teaches you that you can make pragmatic and easy changes in your daily life. You can do this therapy one-on-one or in a group. 

Pharmaceutical Interventions

There are a variety of medications that doctors and psychiatrists have found to help treat depressions. Some are selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), dopamine, and norepinephrine-focused meds like Wellbutrin. Some of these medications can simultaneously treat anxiety and depression, so it’s important to let your doctor know all of your symptoms, especially if they think you’d benefit from pharmaceutical interventions. 

Naturopathic Options

As a naturopathic doctor, I’m not opposed to pharmaceuticals, but I also want people to know that there are well-researched and effective alternatives.  

When looking at the patient, I look at the whole picture - not just the depression and anxiety symptoms because sometimes there are biological causes behind these presenting symptoms. There can be things like hypothyroidism (less so in men), metabolic issues, diabetes, hypertension, lung problems, and restrictions from injuries. When I treat these underlying issues, the depression and anxiety will sometimes subside or go away. 

Exercise

Moderate exercise has been shown to be highly beneficial in minimizing the effects of depression, but of course, that’s a bit of a catch 22. People suffering from depression often don’t feel like exercising, as they feel exhausted and don’t garner joy from things that perhaps used to do so. Their symptoms of depression can often inhibit the desire to exercise, but there’s solid evidence that this will help.

Yoga and Meditation

Again, research supports that these sorts of eastern practices can often serve as a beneficial bridge to traditional western treatments of depression. These practices help calm the brain and cultivate strength in the body and mind. 

Recognizing and Treating Nutritional Deficiencies 

Nutritional deficiencies can cause depression in the sense that you can get a nutritional deficiency-type disease, and that can manifest as depression. A lack of access to eating healthy foods can also lead to heart disease, cholesterol problems, diabetes, obesity, and hypertension. And then, of course, it’s the quintessential chicken or the egg question—did the health issue cause depression, or did depression cause the health issue? 

Treating Vitamin Deficiencies & Herbs

During stressful times when nutrition is also lacking, we may need to increase certain vitamin dosages. Many herbs work well in treating depression and anxiety. These adaptogens can help treat fatigue.

Some of the herbs that I’ve found helpful in treating depression are:

• Rhodiola - studies have shown that this can help with moderate depression

• St. John’s wort (hypericum) is probably the most well known of the herbs we’ve used to help with depression

• Or you can use a combination of herbs that your naturopathic doctor would recommend for you

There are some minor side effects to some of these, like being more susceptible to sunburn, but most people can tolerate them pretty well. They do alter the liver—they can activate, or “upregulate,” more liver enzymes. That’s why you’d need to talk to a doctor to find out if any of these herbs or a combination of herbs would be suitable for you because they can interfere with certain medications by detoxing them too quickly (i.e., hypertension medication). It’s not that they’re dangerous as much as they can render certain drugs ineffective, which, again, is why it’s best to discuss taking them with your doctor.

Newer, More Experimental Approaches

There are newer therapies like brain stimulation and other experimental approaches for really resistant depression that doesn’t respond to antidepressants, psychotherapy, or naturopathic options. 

It’s important to note that the longer you have depression and the more depressive episodes you have, the more difficult it is to treat and the longer it will take to resolve. That’s why it’s critical to have a good grasp on it and seek help right away. 

Some of the questions I ask my patients to determine if they may have depression are:

Do you have little interest in or get pleasure from doing things you used to enjoy? 

Are more than half of your days or nearly every day down days? 

Are you feeling down or hopeless?

What I’d love the biggest takeaway from this article to be is that there is always hope because there are always options. If you worry that you may be suffering from depression and you’d like to explore naturopathic options (and you live in Coronado/San Diego area), contact me today.