What to do about depression
© 2008 Andrew Hall Cutler
1). Anxiety, fear, apprehension = Low GABA problems.
2). Obsessive, compulsive, thinking about bad things, can’t let things go, dream of being run over on the freeway and things like that, think of hurting yourself, lots of psychic distress and suffering = Low serotonin problems.
3). Hopeless helpless crying depression = Problems in the limbic system.
4). No motivation, no energy, don’t enjoy anything, sit around like a bump on a log, unaroused, unaware, but mood OK (you don’t feel DEPRESSED, you just don’t feel much at all) = Low histamine depression.
5). Poor mood, attention deficit, emotionally flat, not much drive or focus = Catecholamine depression.
1 & 2). If you have problems with both GABA and serotonin being too low, you most likely have adrenal problems causing this.
In this case you start with adrenal support, like adrenal cortex and licorice.
For adults, DHEA, 7 keto DHEA and pregnenolone may help (though these should never be used in children, and only in adolescents if they have mainstream endocrinologist documented adrenal insufficiency, for which they are taking replacement doses of hydrocortisone). Also, hydrocortisone itself in less than replacement doses may sometimes be needed, but this is rarely appropriate in children or adolescents and must be used sensibly and with care by anyone who needs it. Once you have some adrenal support regimen in place, then decide what residual depressive symptoms need to be addressed as discussed below.
500-1000 mg of taurine at a time is about right.
2). Serotoninergic depression = use Inositol, 1-3 tsp a day as needed. If that isn’t enough, add tryptophan or 5 HTP. If that still doesn’t do it, consider asking your doctor for an SSRI if you are not chemically sensitive. If you are chemically sensitive, or if you can’t take codeine, you are very unlikely to be able to tolerate SSRI’s. In this case add adrenal support whether or not you think you need it.
Chemically sensitive people who DO need an SSRI have more chance of tolerating Celexa or Lexapro than the others.
3). For limbic problems make sure you have enough thyroid and sex hormones, try B-12 and folic acid in large amounts ONLY if you are not prone to agitation, the nutritional supplement forskolin 10-30 mg 1-3 times a day, maybe try dl-phenylalanine 500 mg 3-4 times a day (if you have a lot of pain or malaise this is good), l-tyrosine 1-3 grams, or the prescription drug selegiline 5-10 mg a day. All the stimulant medications work excellently for this but mostly it is not lawful to prescribe them for this purpose.
4). If you have low histamine depression, IF YOU ARE NOT ALLERGIC AND HAVE NO INFLAMMATORY PROBLEM, try l-histidine 1-3 grams a day. If you are allergic this will make your allergies dramatically worse and you must NOT do it. In that case, take a lot of nonsedating antihistamines and other allergy medications, for example Allegra (fexofenadine) and Singulair or Accolate and Nasalchrom as this may let your body tolerate more histamine. AVOID all medications that have antihistaminic side effects and all antihistamines that get into the brain (which is all the over the counter ones).
5). For catecholamine depression try l-tyrosine 500-3000 mg a day, and forskolin 10-30 mg 1-3 times a day.
If you have a lot of fear or apprehension, sometimes beta blockers or the alpha agonists clonidine or guanfacine will relieve that. These also lower blood pressure. If your blood pressure is already low, you have adrenal problems and need to take more adrenal support before considering these.
If your mood is bouncing all over the place, you may have mood instability and need something for mood stabilization. Most doctors do not know that a lot of these medications work well at lower than normal doses but with much less side effects – the first thing to do if you may need them and aren’t in such bad shape, you need a lot right away to keep yourself out of trouble, is to try 1/4 or 1/2 of the usual amount and see how you do. Most of the choices are Rx, GABA being the most notable OTC choice. GABA has to be taken several times a day. The Atkins diet also helps with this.
If your mood is bouncing and the period is days or longer, it can be you are reacting to dietary issues you haven’t figured out yet, or you are chemically sensitive. In these cases all of the above won’t help much until you avoid the offending foods or chemicals, then you may not need much help.
As a rule, if you really hate the mood stabilizers and don’t want to take them because of how “flat” they make you feel, you truly do need them and it is crucial to take them.
If you find yourself changing your program around a lot because of what is happening to you and are never sure what is going on, try adrenal support, anxiolytics, identifying food and chemical sensitivities, and if those don’t resolve it, then try mood stabilizers.
Most MD doctors just hand out SSRI’s for everyone no matter what kind of depression they have. This is not useful. Find one who will at least try some different stuff. If one or two SSRI’s didn’t work, don’t bother trying any more. Try different kinds of agents. If the doctor doesn’t want to do that, go find a real doctor instead.