Steven V. Joyal
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 This was the strategy Rosemary used to help beat her clinical depression.
"I had type 2 diabetes; I was overweight and depressed," says
DRUGS USED TO TREAT MAJOR OR CLINICAL DEPRESSION
Antidepressants:
?Selective serotonin reuptake inhibitors (SSRIs). These drugs usually produce fewer adverse effects than tricyclic drugs (see below) but are associated with gastrointestinal problems, sleep disturbances, and difficulties with sexual function and desire. Examples include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
?Tricyclics. |
James Dowd and Diane Stafford
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 Q: How can I tell if I have clinical depression or seasonal affective disorder caused by low vitamin D levels?
A: If you experience fatigue, depressed mood, irritability, and/or loss of motivation beginning in the fall, but the problems resolve during the summer or if you travel south in midwinter, you're probably experiencing seasonal affective disorder. Year-round problems with depression point to clinical depression that requires evaluation and treatment. If you experience any of the symptoms listed here, have your vitamin D level checked, or follow the Vitamin D Cure program. |
by Michael Murray, N.D. and Joseph Pizzorno, N.D.
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| It can range from a transient "low mood" to a potentially life-threatening, severe clinical depression.
Signs and Symptoms
Clinical depression is more than feeling depressed. The official definition of clinical depression is based on the following eight primary criteria:
1. Poor appetite accompanied by weight loss, or increased appetite accompanied by weight gain
2. Insomnia or excessive sleep habits (hypersomnia)
3. Physical hyperactivity or inactivity
4. Loss of interest or pleasure in usual activities or decrease in sexual drive
5. Loss of energy; feelings of fatigue
6. |
Charles Barber
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 The wife of the vice president of the United States, Tipper Gore, revealed in a national op-ed that she had suffered from clinical depression.1 In 1999, Bill Clinton convened a high-profile summit meeting on the nation's mental health, and his surgeon general released the first report on that topic. Even George W. Bush, not typically known for his progressive stances, issued his own remarkably forward-looking report on mental health in 2002 and publicly supported "mental health parity"—equality in the insurance coverage of physical and mental ailments. |
David Winston, RH(AHG), and Steven Maimes
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 The category of clinical depression includes major depressive disorder, dysthymia (a milder, chronic form of depression), and bipolar disorder. Depression affects the general quality of life and can complicate other medical conditions. General symptoms of depression include anxiety, poor appetite or overeating, insomnia, low energy or fatigue, muscle pain, low self-esteem, poor concentration, difficulty making decisions, and feelings of hopelessness.
If we can improve our mental condition, we can improve overall health. |
Herbert Ross, DC with Keri Brenner, L.Ac.
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 Evidence is accumulating that environmental estrogens, even at very low concentrations and limited exposure, cause hormone havoc—resulting in autoimmune diseases, clinical depression, and reproductive system disorders, among others.
Though we tend to think of inhaling or ingesting toxins, they can also enter the body in other ways—in particular, through the skin's pores. (Those same pores, of course, also facilitate the elimination of toxic chemicals). Tap water in the United States often contains chlorine, aluminum, pesticides, lead, copper, and other toxic substances. |
Benjamin H. Natelson, M.D.
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 Scores in the teens are very common in medically unexplained illness and really don't mean clinical depression. However, scores in the 20s catch my attention, while scores in the 30s or 40s definitely concern me. Maybe it is because I am not a psychiatrist, but I think the score on the CES-D is every bit as important as the textbook diagnosis of depression in deciding whether to treat a patient for depression. So if you are quite sad and tearful with a tendency to do less than usual but have occasional good moments, you wouldn't be diagnosed with depression. |
Gerald E. Markle and Frances B. McCrea
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 We routinely refer to being "depressed" (which is a distressingly loose set of symptoms) as "clinical depression," which is then explained as a biochemical imbalance. Yet, at least to date, blood, urine, and other body fluids yield no reliable indicator of a problem—for example, that above or below a certain metric the patient suffers from some disease, say something called "depression."13
Is so-called mental illness really an illness?14
A good starting place is to examine the American Psychological Association's (APA) position on this issue. |
| By today's standards," said Fran, "it is obvious that he suffered from clinical depression, presumably..." she thumbed through the volume, "a 'major' and 'recurrent' depressive disorder, most likely 296.3x in DSM-IV-TR.
"I agree. His illness probably was characterized by 'melancholic fea-tures.
"I don't know," retorted Fran. "Given his conversations with God, he probably had 'psychotic features.'"
Throughout most of medical history, he would not have received such a diagnosis. Until the second half of the twentieth century, depression was actually a rare disorder. |
Hyla Cass, M.D.
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 Others may respond more seriously—withdraw from friends and family, find themselves unable to sleep, and head on a downward spiral toward a severe clinical depression. This affects one in five people at some time in their lives. The symptoms of depression are varied (for a listing, see the inset on page 114), and may occur one at a time or in combination, and generally come upon you gradually. They can be also brought on by a crisis.
As a psychiatrist, I'd like to explain depression and its treatment, both areas badly misunderstood by many patients and their families. |
Marshall Editions
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 HOMEOPATHY
Feelings that will respond well to the remedies suggested below are more appropriately described as the "blues," rather than a full-scale episode of moderate to severe clinical depression. The latter can be greatly helped by an experienced homeopathic practitioner. Depending on the severity of the symptoms, these remedies can be helpful as a first choice of treatment, or when used as a complementary measure alongside conventional treatment.
Ignatia: This remedy is helpful if depression follows a loss of any kind. |
Gerald E. Markle and Frances B. McCrea
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| Consider clinical depression, the most common of the mental illnesses. Until recently it was an uncommon diagnosis. Since the development of SSRIs, the diagnosis of depression has increased a thousandfold! The NIMH estimates that in any given one year period, 9.5% of the population, or about 19 million American adults, suffer from a depressive illness. Rates are now similarly high for youth.
Why so much depression? Why so much treatment with SSRIs? |
Charles Barber
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| One of the leading serotonin researchers, Jeffrey Meyer, of the University of Toronto, summed up the misplaced logic of the monoamine hypothesis: "There is a common misunderstanding that serotonin is low during clinical depression. It mostly comes from the fact that many antidepressants raise serotonin. This is a bit like saying pneumonia is an illness of low antibiotics because we treat pneumonia with antibiotics."100 Correlation with serotonin is not necessarily causation by serotonin.101
Furthermore, the monoamine system comprises only a small percent of the neurons in the brain. |
| While SSRIs were first approved as treatment for clinical depression, other uses were steadily added during the course of the 1990s: indications came, one after the other, for obsessive-compulsive disorder, eating disorders, anxiety, and premenstrual dysphoric disorder (a severe form of premenstrual syndrome). The drugs were also used for paraphilias, sexual compulsions, and body dysmorphic disorder. With each new utilization, the market got bigger, lines between distress and disease got blurrier, and the drugs began to be prescribed for problems beyond those indicated by the FDA. |
| At the beginning, her score was twenty-two: solidly in the moderate range of a major clinical depression. We started to see those scores go down. She would complete that form by herself at the beginning of each session, bring it to me, and then we would review it together. We would work on lowering her perfectionistic standards from 100 percent perfect to maybe 80 percent perfect.
"We didn't have to do too much work on behavioral engagement, like increasing the number of pleasurable activities in her life. When she started looking at her thinking, she was able to start to do some things again. |
John J. Ratey, MD
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 The evidence applies not only to clinical depression but also to general attitude. Staying mobile also allows us to stay involved, keep up with people, and make new friends; social connections are important in elevating and sustaining mood.
6. It boosts the immune system. Stress and age depress the immune response, and exercise strengthens it directly in two important ways. First, even moderate activity levels rally the immune system's antibodies and lymphocytes, which you probably know as T cells. |
| This was a cardiovascular risk factor survey that included questions about mood, which is to say they were talking about a broader range of symptoms than clinical depression. Another study, from the epidemiology department at Columbia University published in 2003, surveyed 8,098 people and found the same inverse relationship between exercise and depression.
CONVERGING PATHS
When the blockbuster drug Prozac came along, it was the first antidepressant that corrected the chemical imbalance of just one of the suspect neurotransmitters. |
Marshall Editions
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| DEPRESSION
DIAGNOSIS
It is normal to feel depressed or get a bout of the blues occasionally, but if these feelings start to interfere with your daily life and do not seem to subside, it could be a sign of clinical depression. This can be a life-threatening condition as it can cause people to lose the will to live and may potentially lead to suicide. Depression is certainly a common problem. At least one in every six people will admit to feeling depressed at some point in their life, and one in 20 become clinically depressed. |
Gary Null and Amy McDonald
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 Their peace of mind improves; they are less fatigued; their depression tends to decrease, if it's not true clinical depression from some other cause; their energy level increases; sleep improves; and the quality of their relationships improves. Their state of mind seems to dominate the other way where everything becomes better. It's not a panacea but it's a place to start."
Dr. |
Steven V. Joyal
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| Drug Treatment for Diabetes Patients with Depression
As a treatment option, antidepressants or other drugs used to treat depression can be helpful, preferably as a short-term (less than six months) measure (see "Drugs Used to Treat Major or clinical depression," page 184). Most antidepressants work by helping make certain natural chemicals called neurotransmitters (serotonin, norepinephrine) more accessible to the brain. Neurotransmitters are necessary for normal brain function as well as the control of mood. |
Mark Sircus
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 I know how bad depression can be, because I spent September of 1999 through April of 2000 in a clinical depression that worsened from the beginning. By Christmas the depression suddenly became much worse, nearly suicidal in intensity, and remained that way for four more months. Never did I think that things could go so wrong with my biochemistry that it would cause me to have suicidal thoughts and tendencies. How wrong I was. I had been taking Zoloft (an antidepressant) since 1987 which seemed to take care of my depression. I lived on Zoloft, but by September of 1999, it stopped working ? |
Gabriel Cousens
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 Type-2 diabetics are about three-four times more likely to develop clinical depression than non-diabetics.
There is explicit hope for Type-2 diabetes being completely reversed in a relatively short time. The good news is that Type-2 diabetes is not necessarily a death sentence; rather, it is a benign disease if it is appropriately addressed.
The message is apparent. Uncontrolled diabetes is a forced death march for those who are not willing to make the effort to heal themselves and a disaster in progress for the cultures and economies of nations worldwide. |
| Diabetics are also three-four times more likely to develop clinical depression than nondiabetics.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) reported in 1993 that diabetes is the leading cause of new cases of blindness among adults 20 to 74. Somewhere between 12,000 and 24,000 new cases of blindness per year are caused by diabetic retinopathy. About 60-70 percent of the people with diabetes have mild symptoms to severe forms of diabetic nerve damage. |
by Michael Murray, N.D. and Joseph Pizzorno, N.D.
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| Recurrent thoughts of death or suicide
The presence of five of these eight symptoms indicates clinical depression; an individual with four is probably depressed. The symptoms must be present for at least one month to be called clinical depression.
Causes
Depression can be the result of psychological or physiological factors. The most significant psychological theory is the "learned helplessness" model, which theorizes that depression is the result of habitual feelings of pessimism and hopelessness. |
James Dowd and Diane Stafford
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| Year-round problems with depression point to clinical depression that requires evaluation and treatment. If you experience any of the symptoms listed here, have your vitamin D level checked, or follow the Vitamin D Cure program.
Q: I don't understand how the right diet and vitamin D levels can help me ward off cancer. Everyone in my family has had cancer of some kind, so I figure I have the genetics and it's just a matter of time. Tell me the best way to find out what I can do, or if it will make a difference.
A: Vitamin D slows the cell life cycle down. |
Lynne McTaggart
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 In one healing study of patients suffering from clinical depression, all the patients improved, even the control group, which did not receive healing, largely from the psychological boost created by the possibility of healing.15
In Benson's study the prospect of prayer might have had the opposite effect. According to Larry Dossey, the elegant southern internist and author of many books on prayer,16 the STEP study offered prayer as a "tease," dangled in front of seriously ill patients as something they might or might not be lucky enough to get. |
Dawson Church
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 There is a link between clinical depression, and "a lack of new cell growth in the brain."40 As a consequence, the hippocampi of the brains of depressed patients shrink in time by as much as 15%, as distress and social trauma result in environmental signals that inhibit the expression of experience-dependent genes.41 Our hippocampi are involved in the recall of memories, perhaps while we sleep; such repeated replaying is central to the process of creating durable long-term memories,42 with a beneficial effect on neurogenesis. Psychologist Martin Seligman, Ph.D. |
Gary Null and Amy McDonald
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| When they drag on for a longer period of time, or become much more profound, we may begin to speak of clinical depression.
The causes of depression may include genetic factors. As Dr. William Gold-wag explains, "These may be related to changes in the brain metabolism and the nervous system. We know about genetic factors through the action of certain drugs. We see what chemical changes take place. Obviously our individual chemistry is to a great extent determined by our genes. |
Lynne Mctaggart
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 In one such study, a six-week distant healing study of patients suffering from clinical depression, the test was unsuccessful - all the patients improved, even the control,group who hadn't been subject to healing. But all patients, those receiving healing and those with no healing, may have had a psychological boost from the session, which might have overwhelmed any actual effect of healing.1?
All these considerations represented a tremendous challenge to Elisabeth in putting together a trial. The study would have to be so tightly constructed that none of these variables affected the results. |
Hyla Cass
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| Others may respond more seriously—withdraw from friends and family, find themselves unable to sleep, and head on a downward spiral toward a severe clinical depression. This affects one in five people at some time in their lives. The symptoms of depression are varied (for a listing, see the inset on page 114), and may occur one at a time or in combination, and generally come upon you gradually. They can be also brought on by a crisis.
As a psychiatrist, I'd like to explain depression and its treatment, both areas badly misunderstood by many patients and their families. |
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