Depression is a physical disease per the June 1, 2009 issue of "Frontiers in Bioscinece." Using Positive Transmission Tomography of PET scan imaging decreased activity in three brain regions can be seen in depressed patients. These areas are activated by neurotransmitters, the brain's chemical messengers, which are disrupted in depression.
Treatment approaches for depression, based on this knowledge, should include medication, lifestyle changes and a combination of health education and emotional support, designed to help prevent recurrence and increase the opportunity to find joy in life.
Accessing Treatment
Researchers Laura Pratt, Ph.D. and Deborah Brody, M.P.H. from the Centers for Disease Control and Prevention reported that only 29 percent of Americans with depression sought medical help for the condition. Many reasons for this are possible but at least three of them may be addressed by using primary care providers for treatment, familiarity, ease of getting an appointment and cost.
A family practice physician or family practice nurse practitioner are well equipped to deal with all the factors that contribute to depression, including the need to screen for other diseases that cause mood changes, Not only are they qualified to diagnose depression and prescribe medications, but also they can help with diet, exercise and sleep pattern correction .
Neurotransmitter Errors
Treatment of depression is aimed at correcting the amount and the action of three neurotransmitters, chemicals that carry messages in the brain, according to Sidney Kennedy, M.D. and his colleagues, the authors of "Treating Depression Effectively."
A deficiency of one neurotransmitter, seratonin, causes anxiety, racing or negative thoughts and sleep disruptions in addition to feelings of sadness. In contrast, When norepinephrine is the neurotransmitter that must be adjusted it's hard to focus attention and your, drive to complete tasks are affected. Appetite loss is common in norepinephrine deficiency and a general loss of pleasure is experienced. And according to a group of researchers at the University of Washington, led by Kevin Black, M.D. the third primary neurotransmitter, dopamine, functions to create a memory of pleasurable experiences in the brain. When dopamine is deficient an addiction to one or more substances, including drugs, alcohol, nicotine or sugar can result, compounding depression.
Medications
Knowing which neurotransmitter is deficient is the first step in selecting medication.
When serotonin is deficient it is often because the body is allowing too much of it to be picked up from brain tissues and returned to the blood. Selective Serotonin Reuptake Inhibitors (SSRIs) prevent this process. They include Celexa and Lexapro and the older form, Prozac.
If norepinephrine appears to be at fault medications target both this neurotransmitter and serotonin. The U.S. Food and Drug Administration (FDA) lists Effexor and Cymbalta as Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRI).
And if it is a dopamine deficiency that is suspected, usually because of addition to food or nicotine or other drugs then the norepinephrine-dopamine reuptake inhibitors or NDRI are the appropriate choices, according to the US Food and Drug Administration. These include Wellbutrin, Ritalin and Concerta.
Many other medications have antidepressant activity and each has a unique group of side effects and risks. Determining the right medication and the best dose is matter of experimentation but knowing which neurotransmitter must be targeted makes the process more focused.
Foods
Nutrients from the foods we eat are also known to correct neurotransmitter imbalances and eating patterns can also be put to use to heal the brain's imbalances.
Husband and wife Judith Wurtman M.D. and Richard Wurtman, M.D. from Massachusetts Institute of Technology have discovered that eating one meal each day of only nutrient rich, complex carbohydrates, such as yams, potatoes, brown rice, and vegetables, without any meat, allows the brain to produce more serotonin. But the same researchers, writing in the January 2003 "American Journal of Clinical Nutrition" determined that eating a high protein breakfast was required to increase norepinephrine.
When it comes to dopamine, the American Dietetics Association recommends walnuts and sunflower seeds and warns that caffeine decreases the activity of this brain chemical.
Financial Considerations
One consideration that is easy to overlook, until you're at the pharmacy window, is the cost of a medication.
Since these medications are taken for months or even years it is important to select a drug that is affordable and to decide how much money taking the medication is worth when compared with the costs associated with not treating depression including lower job performance.
Generic medications are generally much less expensive, something that is especially important for the millions of Americans without health insurance.
References
- "Frontiers of Bioscience"; Neurobiology of depression, fibromyalgia and neuropathic pain; Vladimir Maletic, M.D. and Charles L. Raison, M.D., June 1, 2009
- "Psychiatric News"; CDC Finds Most With Depression Fail to Seek Specialized Care; Rich daly; October 3, 2008
- Treating Depression Effectively, 2nd Edition: Sidney Kennedy, M.D. et al: 2007
- "MIT News"; Carbs are Essential for Effective Dieting and Good Mood: E Thomson: February 20, 2004
- US Food and Drug Administration: Understanding Antidepressant Medications
