Depression

Everyone has experienced being sad. The down feeling however is frequently short-lived. When it has become persisted, has affected one’s daily living and cause hurting to the people around, it may already have crossed the boundary of what can be regarded as normal and may be categorized as depression.

Depression is actually a medical illness which has several forms including major depressive disorder, dysthymic disorder, minor depression, psychotic depression, postpartum depression and seasonal affective disorder. ^[1]

Types            

Major depressive disorder is a disabling type typified by at least 5 symptoms on a 2 weeks time. Symptoms include depressed mood, lack of interest in nearly all activities, weight loss or weight gain, changes in sleep pattern, agitation, exhaustion, unworthy feeling, difficulty in concentration and suicidal ideas. If only, 2 to 4 symptoms are observed including loss of interest, then it is regarded as minor depression. Dysthymic disorder is a longer type wherein depression is in attendance for at least two years. Depression here is not serious enough to interfere with the individual’s normal functioning.

Psychotic depression is the term used to apply for the condition when a person has severe depression and psychosis simultaneously. Psychosis may be in the form of false beliefs or hallucinations. Postpartum depression is a kind of depression that is linked with childbirth usually occurring on the first three months after a woman gave birth. The condition is often temporary and mild. However in some cases, it can be continual and may impose harm to both the mother and newborn.  Finally, seasonal affective disorder is a depression experienced when natural sunlight is limited such as in winter.  The atypical symptoms predominate in this category including excessive sleeping and increased appetite. ^{[1] [2] [3]}

Causes

Depression is a product of the interplay of several factors including genes, environment, biological and psychological factors. Stressful experiences can trigger an episode. ^[1]

Diagnosis

The patient’s history is a valuable tool to assess the condition. Physical exam and laboratory exams are important to rule out the possibility of organic causes and substance abuse. ^[1]

Treatment

Treatment is done commonly in the form of medications or psychotherapy. A patient may be given antidepressants such as Fluoxetine (Prozac). ^[1]

 

References:

1.      http://www.nimh.nih.gov/health/topics/depression/index.shtml

2.      http://emedicine.medscape.com/article/286759-clinical#a0256

3.      http://www.medscape.com/viewarticle/528985

 

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Vitamin D [1, 40, 41, 42, 43, 44, 45, 46, 47, 48]:

Please note, this management does NOT treat the condition itself. It may mildly help in preventing some of the symptoms, and even then has insufficient evidence to back up this claim at present. Please note, this acts as a PREVENTATIVE treatment, and not necessarily symptomatic relief.

Recommendation: No recommendation (There is insufficient evidence to support claims that Vitamin D can help prevent mood disorders)

Grade of Evidence: very low quality of evidence

Vitamin B Complex [1, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39]:

Please note, this management does NOT treat the condition itself. It may mildly help in preventing some of the symptoms, and even then has insufficient evidence to back up this claim at present. Please note, this acts as a PREVENTATIVE treatment, and not necessarily symptomatic relief. Supplements should only be taken if they contain no more than 100% of the recommended daily value

Recommendation: Weakly in favor (Vitamin B may help in preventing depression)

Grade of Evidence: moderate quality of evidence

Thuja (Eastern White Cedar, Thuja Occidentalis) [1, 27, 28, 29]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Little is known about the full effects of Thuja, so it is not recommended for medicinal use. Thuja can be poisonous if ingested in large amounts.

Recommendation: no recommendation (There is insufficient evidence to support claims that Thuja helps to treat depression)

Grade of Evidence: very low quality of evidence

Strychnos Nux-Vomica (Maqianzi, Poison Nut) [1, 24, 25, 26]:

WARNING! This substance is HIGHLY POISONOUS. The seeds contain Strychnine, which may cause convulsions, breathing difficulties and death, even if as little as 5 milligrams is ingested

Recommendation: Strongly against (There is no evidence in the form of clinical trials which reports the effectiveness of Strychnos Nux-Vomica, because it is highly poisonous to humans, and is not recommended.)

Grade of Evidence: very low quality of evidence

St John's Wort (Goatweed, tipton weed, Hypericum Perforatum) [1, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly in favor (Clinical trials have shown that St Johns Wort is very effective in the treatment of mild to moderate depression. Studies done with regards to severe depression have yielded mixed results. More studies are needed.)

Grade of Evidence: Low quality of evidence

Megavitamin Therapy (Multivitamin, Vitamin Supplements) [1, 7, 8, 9, 10, 11, 12]:

Please Note that while supplements are effective in correcting deficiencies in the body, their long-term usage is not helpful in preventing diseases like cancer and heart disease. To prevent these illnesses one should eat the natural foods which these vitamins and minerals come from. Replacing natural sources with artificial supplements actually increases the risk of heart disease, cancer, and other diseases. Supplements should be taken only as a balanced multivitamin supplement that contains no more than 100% of the recommended daily allowance. It would be most helpful in people with restricted food intakes, pregnant women and women of childbearing age.

Recommendation: Weakly against (There is no evidence that Megavitamin therapy can prevent or treat depression. In fact, long term therapy can lead to increased risk for other diseases)

Grade of Evidence: moderate quality of evidence

Mugwort (Artemisa Vulgaris) [1, 4, 5, 6]:

Please note, this management does NOT treat the condition itself. It has been proposed only as a weak supportive symptomatic support, and even then, has been discounted due life-threatening side effects

Recommendation: No recommendation (There is insufficient evidence to support claims that mugwart helps to treat symptoms of depression. More research is needed.)

Grade of Evidence: very low quality of evidence

Glyconutrients [1, 2, 3]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation  (Available evidence does not support claims that glyconutrients help to treat depression. More studies are needed.)

Grade of Evidence: low quality of evidence

Neural Therapy:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (no reliable scientific evidence exists that supports Neural Therapy helping to improve symptoms of depression)

Grade of Evidence: very low quality of evidence

Massage:

Recommendation: strongly in favor (studies done strongly support Massage Therapy helping to decrease depression)

Grade of Evidence: moderate quality of evidence

Phototherapy:

Recommendation: weakly in favor (A form of phototherapy, Light Box Therapy has been shown to be effective in treating certain types of deperssion which are caused by insufficient exposure to bright lights. Tests are still being conducted to see if it helps with other forms of depression)

Grade of Evidence: Moderate quality of evidence

Craniosacral Therapy:

Recommendation: no recommendation (No known reliable studies have been done which support positive effects of Craniosacral Therapy on Depression)

Grade of Evidence: low quality of evidence

Yoga:

Recommendation: strongly in favor (randomized control trials have shown that yoga can be of benefit in depression. )

Grade of Evidence: low quality of evidence

Aromatherapy:

Recomendation: weakly in favor (early trials have had positive results, but more research needs to be done)

Grade of Evidence: Low quality of evidence

Curanderismo:

Recommendation: no recommendation (no scientific evidence for claims that Curanderismo can help at all with depression)

Grade of Evidence: very low quality of evidence

Image Therapy:

Recommendation: weakly in favor (Early reviews of studies done show that Image Therapy may help in managing depression, although later studies show some ambiguity)

Grade of Evidence: low quality of evidence

Music Therapy:

Recommendation: no recommendation (Moderate amount of evidence shows that Music Therapy does not help manage depression)

Grade of Evidence: moderate quality of evidence

Native American Healing:

Recommendation: no recommendation (although a study was done, and the results were positive, the methods used and accuracy of the study were highly unreliable)

Grade of Evidence: very low quality of evidence

 * www.gradeworkinggroup.org

 

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://abcnews.go.com/2020/story?id=3228488

3. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/glyconutrients

4. Anliker MD, Borelli S, Wüthrich B. Occupational protein contact dermatitis from spices in a butcher: a new presentation of the mugwort-spice syndrome. Contact Dermatitis. 2002;46:72-74.

5. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/mugwort

6. Fetrow CW, Avila JR. Professional's Handbook of Complementary & Alternative Medicines. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.

7. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/orthomolecular-medicine

8. http://archpedi.ama-assn.org/cgi/reprint/163/2/192.pdf

9. http://www.quackwatch.org/01QuackeryRelatedTopics/ortho.html

10. http://pediatrics.aappublications.org/cgi/content/abstract/72/5/707

11. http://www.ama-assn.org/ama/no-index/about-ama/13638.shtml

12. http://www.ncbi.nlm.nih.gov/pubmed/17327526

13. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/st-johns-wort

14. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-stjohnswort.html

15. http://www.ncbi.nlm.nih.gov/pubmed/18843608

16. http://www.ncbi.nlm.nih.gov/pubmed/11939866

17. http://nccam.nih.gov/health/stjohnswort/ataglance.htm

18. http://nccam.nih.gov/health/stjohnswort/sjw-and-depression.htm

19. http://www.nimh.nih.gov/health/publications/depression/how-is-depression-detected-and-treated.shtml

20. http://www.ncbi.nlm.nih.gov/pubmed/11939872

21. http://www.ncbi.nlm.nih.gov/pubmed/12132963

22. http://www.ncbi.nlm.nih.gov/pubmed/16423519

23. http://jama.ama-assn.org/cgi/content/full/299/22/2633

24.  David Michael Wood et al. Case report: Survival after deliberate strychnine self-poisoning, with toxicokinetic data. Critical Care October 2002 Vol 6 No 5

25. Arnold, M.D., Harry L. (1968). Poisonous Plants of Hawaii. Tokyo, Japan: Charles E. Tuttle Co.. p. 20. ISBN 0804804745.

26. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/strychnos-nux-vomica

27. http://www.nlm.nih.gov/medlineplus/ency/article/002769.htm

28. http://plants.usda.gov/plantguide/pdf/cs_thoc2.pdf

29. http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=thuja&x=0&y=0

30. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/vitamin-b-complex

31. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-folate.html

32. Butterworth RF. Thiamin. In: Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ, editors. Modern Nutrition in Health and Disease, 10th ed. Baltimore: Lippincott Williams & Wilkins; 2006.

33. http://www.ncbi.nlm.nih.gov/pubmed/18220605

34. http://news.bbc.co.uk/2/hi/health/6935482.stm

35. http://www.ncbi.nlm.nih.gov/pubmed/19061687

36. Gropper, S. S, Smith, J. L., Groff, J. L. (2009). Advanced nutrition and human metabolism. Belmont, CA: Wadsworth, Cengage learning.

37. Otten, J. J., Hellwig, J. P., Meyers, L. D. (2008). Dietary reference intakes: The essential guide to nutrient requirements. Washington, DC: The National Academies Press

38. http://recipes.howstuffworks.com/vitamin-b1.htm

39. Higdon, Jane (2003). "Biotin". An evidence-based approach to vitamins and minerals. Thieme. ISBN 9781588901248.

40. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD006164/frame.html

41. http://www.ncbi.nlm.nih.gov/pubmed/10824056

42. http://onlinelibrary.wiley.com/doi/10.1002/jcb.10338/abstract

43. http://pain-topics.org/pdf/vitamind-report.pdf

44. http://informahealthcare.com/doi/abs/10.1185/030079908X253519

45. http://www.theglobeandmail.com/life/article756975.ece

46. http://www.ncbi.nlm.nih.gov/pubmed/17556697

47. http://www.ncbi.nlm.nih.gov/pubmed/18065602

48. http://www.nlm.nih.gov/medlineplus/vitamind.html