By Dr. Mercola
According to the World Health Organization (WHO), depression is now the leading cause of ill health and disability worldwide,1,2 affecting an estimated 322 million people worldwide, including more than 16 million Americans. Globally, rates of depression increased by 18 percent between 2005 and 2015.3
According to the U.S. National Institute of Mental Health, 11 percent of Americans over the age of 12 are on antidepressant drugs. Among women in their 40 and 50s, 1 in 4 is on antidepressants.4
In addition to the human suffering, the financial impact of depression is also severe. WHO estimates the global economic loss by households, employers and governments is at least $1 trillion annually.
Depression is also strongly linked to an increased risk for substance abuse, diseases such as diabetes and heart disease, and suicide.
In the video above, James Chau, a news presenter and WHO goodwill ambassador for sustainable development goals and health, opens up about his personal struggle with depression, and the importance of seeking help and having an open dialogue about the problem.
Depression Is Under-Recognized and Undertreated
According to WHO, a majority of people with depression suffer in silence or do not get adequate care. In high-income countries such as the U.S., an estimated 50 percent of depressed individuals do not get treatment. In low-income countries, that ratio is closer to 80 or 90 percent.
An estimated 6 million seniors in the U.S. also struggle with depression, yet only 10 percent receive treatment.5 Part of the problem relates to lack of funding. On average, governments spend only 3 percent of their health budget on mental health programs. In a statement, WHO director-general Margaret Chan said:6
"These new figures are a wake-up call for all countries to re-think their approaches to mental health and to treat it with the urgency it deserves … For someone living with depression, talking to a person they trust is often the first step towards treatment and recovery."
Unfortunately, the importance of strategies such as optimizing your vitamin D and gut health for the maintenance of mental and emotional stability is still frequently ignored.
Exercise is another widely overlooked remedy that would do far more good than any drug ever will. Below, I'll review these and other common sense treatment alternatives for depression.
That said, if you are feeling desperate or have any thoughts of suicide, call the National Suicide Prevention Lifeline, a toll-free number, at 1 (800) 273-TALK (8255), or call 911, or simply go to your nearest hospital emergency department.
Suicide Rates in US Hit 30-Year High
In the U.S., suicide rates have steadily risen since 2000, primarily in more rural areas7,8,9 — a trend blamed on the effects of social isolation, economic pressures, opioid addiction and limited access to mental health care.
The suicide rate among men is four times that of women, with the highest rates among 35- to 64-year-olds, and those over 75.
Sadly, suicide has also risen sharply among young teens, and antidepressants may play a role in some of these cases. Many antidepressants are known to increase the risk of suicide in children, teens and young adults,10 yet despite such warnings, these drugs are still often prescribed for younger people.
Why Do So Many Veterinarians Commit Suicide?
Curiously, veterinarians have a surprisingly high rate of suicide. According to a 2014 survey by the Centers for Disease Control and Prevention, more than 1 in 6 American veterinarians have contemplated suicide. As reported by The Boston Globe:11
"Veterinarians suffer from feelings of hopelessness, depression and other psychiatric disorders two to three times more often than the general population.
Two studies published in the British Veterinarian Association's journal … found suicide rates are double or more those of dentists and doctors, and four to six times higher than the general population."
Reasons for the high rate of suicide among veterinarians appear to be a combination of financial struggles and having to make difficult life-and-death decisions on a regular basis. Dealing with all-too-human pet owners also appear to be part of what drive veterinarians over the edge.
Dr. Stephanie Kube, a veterinary neurologist and pain pathologist at Veterinary Neurology and Pain Management Center of New England, told the Globe:
"Most of our clients are awesome, and we love them. But all sorts of people have pets. Some adopt or rescue pets who can't take care of them. Some want healthy pets put down.
Some pet owners have emotional disabilities. Some are too financially strapped to pay for veterinary care. And some think vets will do everything for free, because we love animals."
Financial Struggles, Grief and Guilt Can Be Deadly
Veterinary school costs as much or more than regular medical school, yet veterinarians have only one-third of the earning potential of most doctors and dentists, making financial strain a long-term reality for most veterinarians. Add to that the hostility of pet owners upset about the cost of their animal's care.
Veterinarians are also forced to process death, grief and guilt on a regular basis. Each year, an estimated 3 million cats and dogs are euthanized for one reason or another. Neglect and abuse must also be faced far more frequently when you're a veterinarian. NPR shared the following story:12
"Once someone brought in a dog with a bone tumor in its leg. To relieve the pet's pain, a staff member at Magnifico's clinic advised that the limb be amputated. But the owner declined the procedure, tied the dog to a tree in front of the clinic, and left.
Sometimes clients ask for convenience euthanasia. Other times, owners threaten to kill the pet themselves. In those cases, the people at the end of the leash cause the most distress for animal shelter and clinic employees."
Pressed for time, many veterinarians also feel guilty about not being able to offer adequate support to grieving pet owners. As noted by the Globe:
"When these stresses combine with long working hours and on-call pressures, it's easy to see how anyone could melt down. And because vets can offer gentle deaths to their patients with euthanasia, they may see death as a way out of pain. All of them have easy access to drugs that can kill."
Non-Drug Solutions for Depression
Addressing your nutrition is perhaps the best place to start if you're feeling depressed. Foods have an immense impact on your brain, and eating whole foods as described in my nutrition plan will best support your mental and physical health. Avoiding processed foods, sugar (particularly fructose) and grains is particularly important as it will help normalize your insulin and leptin levels, which is an important contributing factor to depression.
Certain nutrients are also known to cause symptoms of depression when lacking, and specific herbs and nutritional supplements may also help counteract symptoms. To suggest that depression is rooted in nutrient deficiencies and other lifestyle related factors does not detract from the fact that it's a serious problem that needs to be addressed with compassion and non-judgment.
It simply shifts the conversation about what the most appropriate answers and remedies are. The following nutrients, herbs and supplements have been shown to be particularly helpful:
✓ Vitamin D / Sun exposure
Many studies have shown that vitamin D deficiency can predispose you to depression, and that depression can respond favorably to optimizing your vitamin D stores, ideally by getting regular, sensible sun exposure.13,14,15
In one such study, people with a vitamin D level below 20 nanograms per milliliter (ng/mL) had an 85 percent increased risk of depression compared to those with a level greater than 30 ng/mL.16
✓ Omega-3 fat
The animal-based omega-3 fat docosahexaenoic acid (DHA) is perhaps the single most important nutrient for optimal brain function, thereby preventing depression. While you can obtain DHA from krill or fish oil, it is far better to obtain it from clean fish like wild Alaskan salmon, sardines, herring, anchovies and fish roe.
Low DHA levels have been linked to depression, memory loss, schizophrenia and Alzheimer's disease.
✓ Folate (vitamin B9) and other B vitamins
Low dietary folate is a risk factor for severe depression, raising your risk by as much as 300 percent.17,18 If you're using a supplement, I suggest methylfolate, as this form of folic acid is the most effective.
Other B vitamin deficiencies, including B1, B2, B3, B6, B8 and B12 also have the ability to produce symptoms of neuropsychiatric disorders. Vitamin B12 deficiency, in particular, can contribute to depression and affects 1 in 4 people.
✓ Antioxidant-rich foods
Eating plenty of fruits and vegetables is associated with lower odds of depression and anxiety,19,20 an effect ascribed to antioxidants that help combat inflammation in your body. Chronic inflammation is thought to be one of the primary causes of depression.
✓ St. John's Wort (Hypericum perforatum)
This medicinal plant has a long historical use for depression, and is thought to work similarly to antidepressants, raising brain chemicals associated with mood such as serotonin, dopamine and noradrenaline.21
✓ S-Adenosyl methionine (SAMe)
SAMe is an amino acid derivative that occurs naturally in all cells. It plays a role in many biological reactions by transferring its methyl group to DNA, proteins, phospholipids and biogenic amines. Several scientific studies indicate that SAMe may be useful in the treatment of depression.
✓ 5-Hydroxytryptophan (5-HTP)
5-HTP is another natural alternative to traditional antidepressants. When your body sets about manufacturing serotonin, it first makes 5-HTP. Taking 5-HTP as a supplement may raise serotonin levels. Evidence suggests 5-HTP outperforms a placebo when it comes to alleviating depression,22 which is more than can be said about antidepressants.
This Chinese herb, available from doctors of traditional Chinese medicine (TCM), has been found to reduce the effects of "chronic and unpredictable stress," thereby lowering your risk of depression.23
✓ Prebiotics and probiotics
Your mental health is closely linked to your gut health. A number of studies have confirmed chronic inflammation, and especially gastrointestinal inflammation, can play a critical role in the development of depression.24 In fact, researchers have suggested "depression may be a neuropsychiatric manifestation of a chronic inflammatory syndrome."25
Your gut is considered to be your second brain, created from the identical tissue as your brain during gestation. It's important to understand that your gut bacteria are an active and integrated part of serotonin regulation and actually produce more serotonin than your brain.
Optimizing your gut flora is a key part of the equation to optimize your serotonin levels. Gut bacteria also play a role in GABA regulation, and lower the stress-induced hormone corticosterone, resulting in reduced anxiety and depression related behavior.26
To nourish your gut microbiome, be sure to eat plenty of fresh vegetables and traditionally fermented foods. Healthy choices include fermented vegetables, lassi, kefir and natto. If you do not eat fermented foods on a regular basis, taking a high-quality probiotic supplement is recommended.
Also remember to severely limit sugars, especially fructose, as well as grains, to rebalance your gut flora. As a standard recommendation, I suggest limiting your daily fructose consumption from all sources to 25 grams per day or less.
✓ Evaluate your salt intake
Sodium deficiency creates symptoms that are very much like those of depression. Make sure you do not use processed salt (regular table salt), however. You'll want to use an all-natural, unprocessed salt like Himalayan salt, which contains more than 80 different micronutrients.
✓ Make sure your cholesterol levels aren't too low for optimal mental health
Low cholesterol is linked to dramatically increased rates of suicide, as well as aggression toward others.27 This increased expression of violence toward self and others may be due to the fact that low membrane cholesterol decreases the number of serotonin receptors in the brain, which are approximately 30 percent cholesterol by weight.
Lower serum cholesterol concentrations therefore may contribute to decreasing brain serotonin, which not only contributes to suicidal-associated depression, but prevents the suppression of aggressive behavior and violence towards self and others.
Other Lifestyle Factors That Can Greatly Impact Your Risk for Depression
The following lifestyle factors can also play a significant role in depression.
• Exercise. Studies have shown there is a strong correlation between improved mood and aerobic capacity. There's also a growing acceptance that the mind-body connection is very real, and that maintaining good physical health can significantly lower your risk of developing depression in the first place.
Exercising creates new GABA-producing neurons that help induce a natural state of calm. It also boosts your levels of serotonin, dopamine and norepinephrine, which help buffer the effects of stress.
Recent animal research also suggests exercise can benefit your mental health by allowing your body to eliminate kynurenine, a harmful protein associated with depression.28 According to Dr. James S. Gordon, a world-renowned expert in using mind-body medicine to heal depression:
"What we're finding in the research on physical exercise is that exercise is at least as good as antidepressants for helping people who are depressed… [P]hysical exercise changes the level of serotonin in your brain. And it increases your endorphin levels, your "feel good hormones."
• Sleep. Sleep and depression are so intimately linked that a sleep disorder is actually part of the definition of the symptom complex that gives the label depression. Ideally, get eight hours of sleep each night, and address factors that impede good sleep.
• Excess EMF exposure. Studies have also linked excessive exposure to electromagnetic fields (EMFs) to an increased risk of both depression and suicide.29 Powerlines and high-voltage cables appear to be particularly troublesome. Addiction to or "high engagement" with mobile devices can also trigger depression and anxiety, according to recent research from the University of Illinois.30
It would be wise to limit exposure and/or shield yourself from Wi-Fi routers by turning them off at night, not carrying your cellphone on your body, and eliminating the use of portable phones. At bare minimum, do not keep portable phones, cellphones and other electric devices in your bedroom.
• Spending time outdoors has been shown to dramatically improve people's mood and significantly reduce symptoms of depression. Outdoor activities could be just about anything, from walking a nature trail to gardening, or simply taking your exercise outdoors. According to a 2007 report on Ecotherapy by the British Depressionalliance.org:31
"[Ninety-four] percent of people taking part in a MIND survey commented that green exercise activities had benefited their mental health; and 100 percent of volunteers interviewed during an outdoor conservation project agreed that participation benefited their mental health, boosted self-esteem and improved confidence."
• Stress. I believe it's helpful to view depression as a sign that your body and life are out of balance, rather than as a disease. It's a message telling you you've veered too far off course, and you need to regain your balance. One of the key ways to do this involves addressing negative emotions that may be trapped beneath your level of awareness. My favorite method of emotional cleansing is Emotional Freedom Techniques (EFT), a form of psychological acupressure.
Research has shown that EFT significantly increases positive emotions, such as hope and enjoyment, and decreases negative emotional states.32,33,34 EFT is particularly powerful for treating stress and anxiety because it specifically targets your amygdala and hippocampus, which are the parts of your brain that help you decide whether or not something is a threat.35
For serious or complex issues, seek out a qualified health care professional that is trained in EFT36 to help guide you through the process. That said, for most of you with depression symptoms, this is a technique you can learn to do effectively on your own. In fact, it's so easy that children are learning it. In the videos below, EFT practitioner Julie Schiffman shows how you can use EFT to relieve symptoms of depression.
As a general rule, it would be wise to remember that your lifestyle can quite literally make or break your health well-being and may be one of the most fundamental contributors to depression. The most appropriate answer, then, is to get to the root of the problem, and not ignore it by popping pills.
You'd be well advised to address the factors discussed in this article before resorting to drug treatment — which science has shown is no more effective than placebo, while being fraught with potentially dangerous side effects. For even more inspiration, please see my previous article 13 Mind-Body Techniques That Can Help Ease Depression.