Friday, March 16, 2012

Depression - An Integrated Medical Approach

Depression can be caused by many different reasons. There is no one treatment miracle cure that will work for everyone.

We find that by combining the approaches of modern science with the principles of Traditional Chinese Medicine give patients a fast recovery and returning to a normal mood that is less likely to regress.

According to modern medicine depression can be caused by genomic expressions, severe chronic illness, metabolic disorders like hypothyroidism and diabetes, toxicity of copper and other heavy metals, nutritional deficiencies such as iron, zinc, B12, B9, B3, Vitamin D, Vitamin C, chromium and magnesium, low amino acids tyrosine not converting to serotonin, liver issues causing methylation problems (discussed in more detail) and more.

According to Chinese Medicine depression can stem from blood deficiency, this is where most post natal depression stems from and is closely linked with iron and B vitamin deficiencies, liver qi stagnation, and issues with the lung, heart and kidney organs.

This information can seem overwhelming. How do you know the best place to start to treat your depression?

The most typical Chinese Medicine pattern of disharmony of depression seen in our clinic stems from either the Liver energy or the Kidney energy not working the way it should. In Chinese Medicine we talk about the Liver and Kidneys in a broader sense than the medical world, sometimes it can correspond to a detectable problem with your Liver or Kidney organs, but mostly it is occuring on a subtler functional or energetic level.

If you are suffering more anger than ambivalence then your practitioner is more likely to suspect that the Liver energy needs to be treated. Subtle signs and symptoms will bring a qualified Chinese Medical practitioner to diagnose their patient’s organ pathology however, and one must seek diagnosis and treatment from a qualified professional.

When you’re being treated from a modern medical perspective you must be tested. Blood tests can determine genetic polymorphisms (which can be treated), vitamin deficiencies, and thyroid conditions. Functional pathology labs can test for how your liver clears toxins away and which amino acids you're lacking, which make ‘depression relevant’ compounds.

Together both systems compliment each other, and patients who receive treatment from both modalities tend to recover faster.

The LIVER

Is the storage site for many essential vitamins and minerals, such as iron, copper, B 12, and vitamins A, D, E and K. The liver is known as the detoxification organ, not only of external chemicals and pollutants, but also hormones that are made in the body, which constantly need to be broken down and turned into excretable substances. When hormones are not cleared properly from the body they aromatize into other hormones which creates hormonal imbalance, disrupting mood dramatically.

The role of these various enzyme activities in the liver is to convert fat soluble toxins into water soluble substances that can be excreted via the kidneys in the urine or via the gall bladder in the bile. Therefore to detoxify properly one needs their kidneys and gallbladder to be functioning properly. A gall bladder flush is a great place for people to start when detoxing or having difficulty digesting fats, speak to a complementary therapist to be assisted through this process.

A process known as methylation also occurs in the liver. This process is critical to the metabolism of dopamine, norepinephrine and epinephrine which are thought to be directly related to symptoms of depression, anxiety and other mood disorders. Methylation  synthesizes ‘depression-relevant' compounds such as melatonin, serotonin, dopamine, adenosine, glutathione, GABA, sulfate, cortisol, carnitine, CoQ10 and more. Methylation is also required to inactivate histamine, the inflammatory compound involved in immune reaction such as hayever and allergies. 

Basic nutrients necessary for normal function of this cycle include B12, glycine, serine, activated B6, selenium, cysteine, methionine and folic acid, hence B vitamins and amino acid deficiencies influence the expression of depression.

Several studies have shown the utility of folic acid in the treatment of depression. Some people carry genes that cause then to be deficient in folic acid. This is common in people who has depression that runs in the families.  Carrying the MTHFR gene means that folate (B9) is poorly activated, which means that they can not recycle their homocystine back into methionine. High levels of homocystine not only impact in the development of depression but also heart disease, colon cancer, and gives rise to a higher incidence of neural defects in babies and autism.

If depression stems from poor liver function then alongside vitamin and amino acids there are an array of herbs useful for liver detox and function. 


Lifestyle Choices

Eat less processed foods, and more freshly cooked meals. When eating out, choose meals that are prepared with less oil, sugar and salt. The best cooking methods are stir frying, poaching and steaming. Schedule main, heavier meals for the earlier part of the day where possible. Simplify your meals, don’t have too many food groups in one meal.

Increase folate rich foods: vegetables, especially green leafy vegetables and red vegetables. Aim for 3 cups of vegetables each day, and minimum of 2 pieces of fruit each day. 6-8 glasses of water each day as a target, more in summer.

To increase vitamin absorption and reduce inflammation try gluten and casein (dairy protein) free foods.

A high protein diet will contribute to “qi stagnation”; it is best to focus on the quality of protein consumed rather than the quantity, look for fish that is fished out of Australian or New Zealand waters. Your diet should be high in leafy green vegetables, moreso than focused on protein.

Check packaging for additives, sugar and salt. Try to choose brands without preservatives, and with sugar and salt lower on the list. Remember that ingredients are listed from highest to lowest content. Avoid MSG (and related additives) wherever possible. Look for numbers 620-640 (flavour enhancers). Number 621 is MSG. Artificial sweeteners should also be avoided where possible.

Reduce caffeine, carbonated drinks, alcohol, cigarettes, recreational drugs, fatty foods, sugar and salt. Replace with herbal tea or coffee substitute, water or diluted fresh juice, freshly cooked meals.

Avoid eating too late in the evening, try to have your final meal by 7pm. Your body needs to rest at night, not spending all night digesting your dinner. Your energy levels can be quite low in the morning if you’ve had a large meal before going to bed.

Be guided through a detox with an experienced healthcare provider, physically and emotionally.

Turbulent or volatile emotions at meal times are especially detrimental; meals should be eaten in a calm and relaxed environment. Relax whilst you’re eating and enjoy your food, and avoid eating whilst working, reading or watching TV. Ensure to leave adequate time each day to relax, whether meditating, listening to music, gardening etc. or some other form of activity that doesn’t involve reading or watching TV.

Move Qi (energy), don’t exhaust it. This means look at how you exercise, long distance running, crossing training for hours at a time and exercising in elevated temperatures typically exhaust qi. This can sometimes be detrimental to your progress, back off on the exercise if you suspect that your mood is adversely affected. Low intensity exercise such as light jogging, power walking, cycling and swimming is preferable. Yoga, pilates and tai chi are also excellent ways to get stuck energy moving.

Reducing your workload and the amount of time you spend at work, spending time at least once each week doing something you enjoy. Where possible, get to bed before 11pm, try to avoid burning the candle at both ends. Remain conscious of where your true energy levels are and avoid “running on empty”.

Start exercising lightly, qi gong, tai chi, hatha yoga, swimming, walking, gardening.

Depression From Exhaustion

According to Chinese Medicine your practitioner could identify that you have Qi and Blood deficiency. This is usually associated with a weak digestive system. It's vital to check your pancreatic enzymes are ok, so that you are producing the right enzymes to effectively digest your food. Practitioners at our clinic can arrange these tests for you, alternatively you can see your GP.

Low iron is sometimes linked with Qi and Blood deficiency, this can be from an inherited tendency, it could be from a parasitic infection, low dietary intake, or poor absorption. All causes of low iron can be treated, and can make a big difference in your mood. Ensuring that your iron stores (ferritin) are adequate to support great health is essential, we like our clients to bring their blood test results along so that we can see how closely your levels align with the metrics of great health, rather than using a metric that indicates the absence of disease. It is with a fresh perspective that often times clients can unravel problems that have plagued them for years.

If your practitioner diagnoses Blood deficiency and you are a woman, it's especially important to resolve the problem quickly if you suffer from menorrhagia, heavy bleeding during your menstrual cycle.

General Principles for Eating to improve absorption of vitamins and minerals from food, and to tonify a weak digestive system:
    Absolutely avoid all raw food including salads.
    All foods to be cooked and eaten warmed, long slow cooking, soups, broth & stews,
    Thorough chewing,
    Simple combinations of a few ingredients,
    Smaller meals more often,
    Regular meal times
    No excess fluid with meals, overeating, missing meals or eating while working.
    Avoid food that is more than one day old. 
    Don’t eat when you are upset or angry.

Increase protein intake, the best source of protein is animal protein, especially organic chicken (soups and stock), and green leafy vegetables are high in Iron content.  In vegetarian diets folic acid and Vit B12 can be taken as supplements.

Adrenals

Adrenal exhaustion can be a major contributor to depression, to test your adrenal output you can do a saliva cortisol test through the day to see how your cortisol varies from day to night.

For those with high or low cortisol should stay away from stimulants! Eating small and regular meals that contain good sources of proteins and fats can also help nourish the adrenals. Learn how to relive stress and REST!

An adaptogenic tonic can balance your adrenal hormones which can help your energy out put feel even throughout the day. This sis a great way to help you come off the abuse of stimulants, which just keep draining your adrenals, and creating energy fluxes throughout the day.

The Chinese believe that as heat is a source of energy, you should not allow heat to escape from the Kidney adrenal region. This can happen either around the lower back and abdomen or through the Kidney meridian at the sole of the foot. Keep the back and feet warm, and prevent Qi loss.

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