Posted
Monday, October 05, 2009
It is well established that, in meta-analysis of placebo controlled trials, anti-depressant drugs work slightly better than placebos. The difference is enough to be statistically, but not clinically significant. However, Irvine Kirsh’s analysis, explained in his book The Emperor’s New Drugs (Bodley Head) shows how a) most people on these trials guess they are on anti-depressants due to side-effects and b) the more side-effects the better their improvement and c) placebos that induce side-effects enhancea person’s response. The difference between anti-depressant response and placebo is simply explained by an enhanced placebo response. In trials where placebos that also induce side-effects are given there’s no difference. There’s no evidence that increasing the dose works, which it what most doctors do. Also, most reported benefit occurs in the first two weeks so the often used explanation that you just haven’t taken them for long enough is not true.
However, what’s really worrying are the side effects which include at least a doubling of risk of suicide, sexual dysfunction, insomnia, nausea, diarrhoea, sweating, drowsiness, a possible increased risk for heart disease and, recently, some concerns about negative effects on babies in pregnant women taking anti-depressants. All in all, they are a bad deal.
Today a study in the Archives of Psychiatry shows that you cut your risk of depression by more than 30% by eating a Mediterranean style diet. This confirms many studies that show a link between blood sugar problems, ‘metabolic syndrome’, weight gain and depression. The best solution is a low GL diet, high in omega 3 fats.
The evidence for omega 3 fats helping depression is now substantial with almost a dozen positive trials. The best results are reported on 1,000mg of EPA, which is the equivalent of two high strength EPA capsules. The side-effects are healthier skin, joints and arteries.
5-HTP, the most active form of tryptophan, the precursor of serotonin, also has consistently positive results. You need 100 to 300mg. However, don’t combine 5-HTP with anti-depressants. Chromium, at 600mcg a day, has proven effective in two trials of people with ‘atypical’ depression. This is characterised by feeling tired all the time, carb cravings, weight gain and being over-emotionally sensitive. Both psychotherapy and exercise are also proven to help.
Fran K is a case in point. Her story speaks for itself: ” I was originally diagnosed with clinical depression four years ago following a bereavement and was prescribed an SSRI and was referred for counselling, and assumed that was what you did when you felt low. Two years later I had gained 6 stone, had severe memory loss and just about every muscle in my body was cramped. Whenever I tried to explain these concerns it was like I was speaking a different language. It wasn’t that I didn’t want to get out of bed, I actually physically couldn’t - my legs would buckle and then I’d collapse, for example. Self confidence was absolutely nil and I tried lots of different things. Reading the medical literature and realising that there wasn’t a lot of consensus on what actually causes depression. I read every self-help book going, changed my diet, got colonics, got spiritual healing – you name it, I tried it! But I just seemed to be getting worse. I even tried to wean myself off twice and that made things worse. I realised I felt that I was between a rock and a hard place. The someone recommended Patrick’s book. So I read Optimum Nutrition for the Mind, cover to cover that night, and it was so exciting after all those years to realise actually they might be really be something out there. I asked my GP if he wouldn’t mind having a quick read and telling me is this for real. And he did, and told me to go for it. Interestingly enough, when I told the psychiatrist, I was threatened with hospitalization, so I decided to trust my GP on that one. I made an appointment with the
Brain Bio Centre . It was just so exciting to be asked sensible questions and to be treated like an intelligent person. When the tests came back, that was beyond empowering. To have Lorraine, the clinical nutritionist, actually say ‘I’m looking at these results and I’m wondering how on earth you’ve even been getting out of bed’ – she wasn’t calling me lazy or a negative thinker. So we designed a supplement plan and in one month I started noticing changes. By April of this year, I made such progress that I was actually investigated for benefit fraud! The only way to clear my name was to show receipts of supplements and the treatments. By June, I completed the coast-to-coast walk, all 200 miles of it, carrying my own gear. By July I completed a 10 day meditation course and by August I was back working full-time and going to the gym everyday.”
The Brain Bio Centre was founded six years ago to offer state-of-the-art treatment for mental health conditions using nutrition rather than drugs. It has a team of psychiatrists and clinical nutritionists who can work with your doctor.
If part of the cause of your condition is to do with biochemical imbalances in the brain then a nutritional approach is more likely to help than anti-depressants. Biochemical imbalances can result in disperceptions and that is at the heart of your condition. At the Brain Bio Centre you are tested for a number of specific biochemical imbalances and, in truth, if they all come back as normal then the odds of being helped are considerably less than if imbalances are found.
Since you have been suffering from some 15 years I would suggest that this is something worth finding out. The team at the Brain Bio Centre would also advise you about other important avenues to explore.
Posted by patrick on 10/17 at 12:18 PM
Hi, is there any similar type of centre in South Africa by any chance?
Posted by Nicola Hartel on 10/20 at 01:01 PM
Sadly not. Your best bet is to contact the South African Association of Nutritional Therapy (saant.org.za) and find a practitioner who is well up on this area. This includes some graduates of our Institute for Optimum Nutrition, who i train in mental health. They have a DipION after their name.
Posted by patrick on 10/21 at 03:48 AM
I am following this advice and believe it works but am nervous (no pun) about the EPA / DHA balance which I had always supplemented fairly equally. There seems to be growing evidence in research papers that increasing EPA and minimising DHA is beneficial for the treatment of depression and some other mental health areas, and that increased DHA can actually stop the EPA working. I’ve also read that Omega 6 is necessary to balance out the Omega 3. I’d be interested in an opinion on this DHA and Omega 6 intake, and on whether healthy people should also prioritise EPA as a means of maximising brain health, in that it is a precursor to DHA in any event.
Posted by SteveK on 11/25 at 03:27 PM
DHA on it’s own has generally proven ineffective for depresssion. The reason why EPA has much more beneficial evidence is largely because there is a prescribably form of ethylEPA that is being used in most clinical trials. It has a much higher EPA concentration that a straight fish oil, hence you can take less. I don’t think the form of it is any better and it would make sense to take omega 3 fish oils in the form provided in nature, ie together with DHA. Omega 6 is always necessary and, in relation to ADHD, the combination of both seems to work well. I am not sure there’s any evidence of omega 6 itself (GLA being the most potent source) being particularly effective for depression.
My position is that, much like with individual Bs, it is best to have a basic supplement containing both omega 6 (GLA) and omega 3 (EPA.DHA and ideally DPA), but ten times more total 3 to 6, then add on concentrated omega 3 for conditions that warrant it, such as depression.
Posted by patrick on 11/26 at 04:43 AM
