Major depressive disorder (MDD) is a complex mental illness with a wide variety of causes and manifestations. It’s different from regular sadness that a person might feel if they lose a job, for example, and it’s even different from the feeling of grief after the death of a loved one, even though the bereavement process can share the same features as depression. When someone suffers from major depression, they experience periods of persistent sadness and withdrawal from previously enjoyed activities. Those with major depression also experience significant issues with self-esteem and struggle with feelings of worthlessness. These symptoms, experts explain, are caused by a complex array of billions of chemical processes, working both inside and outside nerve cells, that affect your mood and perceptions. In addition, some individuals are more vulnerable to developing depression or another mood disorder based on their genetics, which have a large impact on how we handle stress. Further, individuals whose genetic makeup makes them more sensitive to stressful life events, such as loss, trauma, illness, or abuse, might develop depression in response to these events. If this trauma or loss happens early in life, this can resonate throughout that person’s life, becoming a catalyst for depression into adolescence and adulthood. Put simply, depression occurs when certain genetics, biology, and varying degrees of stressful life events come together.1

SIGNS AND SYMPTOMS OF MDD

The American Psychiatry Association2 lists the following characteristics as symptoms of mild- to-severe depression. Let your doctor know if you’ve been experiencing any of these symptoms for at least two weeks:

• Feeling sad or depressed
• Loss of interest in activities and hobbies once enjoyed
• Changes in appetite—either eating more or less than is normal for you
• Inability to sleep, or sleeping too much
• Loss of energy and increased fatigue
• Increase in “purposeless activity” (e.g., hand-wringing, pacing) or slowed movements and speech
• Persistent feelings of worthlessness or guilt
• Difficult thinking, concentrating, and/or making decisions
• Suicidal ideation or thoughts of death

TREATMENT

If you are diagnosed with depression, the good news is there are plenty of treatment options available, and 80 to 90 percent of people with MDD eventually respond well to treatment. The American Psychiatry Association2–3 says that depression is among the most treatable mental disorders. Currently, standard treatment options for depression include medication, psychotherapy, and, for more severe and treatment-resistant MDD, electroconvulsive therapies.

Medication. Evaluation by a qualified doctor will determine if a person with depression is a good candidate for medication. Whether an individual will benefit from medication will be based, at least initially, on whether the individual’s depression is due to a life change (e.g., bereavement, loss of job) or a more long-term chemical imbalance in the brain. Life changes that cause depression usually (but not always) will resolve with time. However, if depressive symptoms are ongoing, it likely is due to an imbalance of certain chemicals in the brain. In these cases, a psychiatrist or other healthcare professional qualified to treat depression will prescribe an antidepressant—medicine that is neither a sedative nor a stimulant and is not habit forming. Then, the patient and psychiatrist will work together to monitor symptoms and side effects over the course of weeks and months, in order to pinpoint the best antidepressant type and dosage for the patient. For more information on the types of medication often prescribed for depression, visit www.mayoclinic. org and type “antidepressants” in the site’s search window.

Psychotherapy. Psychotherapy, otherwise known as “talk therapy,” can be used alone as a treatment for mild depression, and is usually used in conjunction with antidepressants in cases of moderate-to-severe depression. During psychotherapy, therapists commonly utilize cognitive behavior therapy (CBT), a method that helps their patients recognize the distorted thinking characteristic of depression and develop strategies to change this thinking. For more information on the different types of psychotherapy used to treat depression, visit www.apa.org and type “psychotherapy for depression” in the site’s search window.

Electroconvulsive Therapy (ECT).

ECT is a treatment that has been used since the 1940s, but major improvements to the treatment have been made since then. This treatment is another option for patients with severe depression or bipolar disorder who are considered “treatment-resistant” (i.e., have not responded to medication or psychotherapy). The process involves brief electrical stimulation of the brain while the patient is under anesthesia, and these treatments occur 2 to 3 times weekly for up to 12 treatments. For more information on ECT, visit https://www.psychiatry.org/ patients-families/ect.

THE EFFECTS OF DIET AND EXERCISE ON DEPRESSION

Sugar and depression. Sugar is commonly known as an enemy to our waistlines, but could sweets be damaging to our mental health as well? Science suggests so. In a recent study published in Scientific Reports, researchers analyzed data from observations on 25,000 men and found that men who consumed more than 67 grams of added sugar daily were 23-percent more likely to develop anxiety, depression, or another mental disorder after five years.4 The Dietary Guidelines for Americans recommend that added sugar (that is not naturally occurring such as in fruit) should make up no more than 10 percent of total daily calories for adults and children. That means if someone eats a 2,000 calorie-a-day diet, they should consume no more than 50 grams of added sugar, if any. The recent study in Scientific Reports is notably different from studies that have come before it, claim the authors, because no other study has examined the role of “reverse causation.” In other words, if people with anxiety and/or depression tended to consume more sugary foods and drinks, this could be the real reason why a link between sugar intake and poorer mental health has been observed. However, in this study, the researchers this link was not observed. The researchers found that men and women were not more likely to consume more sugar due to their depression but rather those that consumed more sugar were more likely to develop depression.4

Exercise. Have you ever completed a particularly intense workout and felt calm, happy, and energized afterward? This “runner’s high” can bring great relief to those suffering from MDD. A recent study published in the American Journal of Psychiatry showed that even small amounts of exercise, as little as one hour per week and at any intensity, can be effective in preventing depression.5

Not only can regular physical activity prevent depression, but multiple studies have proven it to be a viable treatment for the disorder. In one study, 30 participating patients with moderate depression were randomly assigned three courses of treatment: an exercise regimen of walking for 20 to 40 minutes, three times weekly; a social support group; or no treatment, acting as the control group. After six weeks, patients who participated in the exercise program saw the most effective results in alleviating symptoms of their depression.6 Even better, another study showed that these effects can be long lasting; in this study, patients participated in a 12-week fitness program, saw significant improvements in their depressive symptoms, and then maintained many of these improvements during a 12-month follow up period.7  In addition to cardiovascular exercise, several studies show yoga can provide relief for people with depression.8 Studies were presented at the Annual Convention of the American Psychological Association this past August that explored the antidepressant effects of yoga. One such study focused specifically on hatha yoga, a form of yoga that joins together physical, breathing, and meditative exercises in order to enhance all-around wellbeing. The study recruited 23 male veterans to participate in twice-weekly yoga classes for eight weeks. After the program had been completed and the researchers surveyed the veterans, those with previously elevated depression scores saw a reduction in their symptoms. In another study, researchers focused on Bikram yoga, or “hot yoga,” which takes place in a heated room. This study observed 29 adults with depression attending Bikram yoga classes at least twice a week for eight weeks. Participants surveyed after eight weeks displayed decreased symptoms of depression and improved quality of life, optimism, and cognitive and physical functioning. The authors added that the more the participants attended the classes, the lower their depressive symptoms were at the end of the study.8

VITAMINS AND SUPPLEMENTS

Studies have shown that individuals struggling with mental health disorders display a severe deficiency in many essential vitamins, minerals, and omega-3 fatty acids, with fatty acids being the most common deficiency.3,9 Patients have shown improvements in their symptoms after being provided with daily supplements of these vital nutrients. Specific supplements that have proved beneficial in the treatment of major depression include tryptophan, tyrosine, gamma-Aminobutyric acid (GABA), omega-3 supplements, vitamin B, magnesium, and S-adenosyl methionine (SAM).10 If you are dealing with depression or suspect you are experiencing depression, talk with your doctor before attempting to treat yourself with any of these over-the-counter supplements.

REFERENCES

1. What causes depression? April 11, 2017. Harvard Health. https://www.health.harvard. edu/mind-and-mood/what-causes-depression.

Accessed Dec 12 2017.
2.American Psychiatric Association. The Diagnostic

and Statistical Manual of Mental Health Disorders, Fifth Edition. Washington, DC: American Psychiatric Press,

Inc.;2013.
3. Parekh R. What is depression? January 2017. American

Psychiatric Association. https://www.psychiatry.org/ patients-families/depression/what-is-depression. Accessed Dec 12 2017.

4. Knuppel A, et al. Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study. Sci Rep. 2017 Jul 27;7(1):6287.

5. Harvey SB, et al. Exercise and the Prevention of Depression: Results of the HUNT Cohort Study. American Journal of Psychiatry. 2017;1.

6. McNeil JK, LeBlanc EM, Joyner M. The effect of exercise on depressive symptoms in the moderately depressed elderly. Psychol Aging. 1991 Sep;6(3):487–8.

7. DiLorenzo TM, et al. Long-term effects of aerobic exercise on psychological outcomes. Prev Med. 1999 Jan;28(1):75–85.

8. American Psychological Association. Yoga effective at reducing symptoms of depression. ScienceDaily. August 2017. www.sciencedaily.com/ releases/2017/08/170803152917.htm. Accessed Dec 12, 2017.

9. American Psychological Association. Stress in America: Coping with Change. Feburary 2017. https://www.apa.org/ news/press/releases/stress/2017/technology-social-media. PDF. Accessed Dec 12 2017.

10. Lakhan SE, Vieria K. Nutritional therapies for mental disorders. Nutrition Journal. 2008;7:2.