Depression: disease or symptom?

Have you suffered challenges to your mental health?

Depression has the third highest burden of all diseases in Australia (13%) [1] and also third globally [2].

Almost half (45%) Australians will experience a mental illness in their lifetime [3].

One in five, about 20%, Australians aged 16-85 experience a mental illness in any year:

• 11.5% have one disorder and 8.5% have two or more disorders.
• 14% of Australians suffer from anxiety disorders.
• 6% depressive disorders [4].

The age with the highest prevalence of mental illness is between 18-24 years of age.

21.2% of adolescents between 15-19 years of age met the criteria for a probable serious mental illness [5].

Six Australians die from suicide every single day, with a further 30 people will attempt to take their own life [6].

Suicide is the leading cause of death for people Australians aged 25-44 and the second leading cause of death for young people aged 15-24 [7].

Australians are more likely to die by suicide than skin cancer.

Indigenous Australians experience double the rate of suicide when compared to non-indigenous Australians [8].

The LGBT community experiences four times the rate when compared with those identified as heterosexual [9].

In 2011, men accounted for 76% of deaths from suicide [10], yet an estimated 72% of males don’t seek help for mental disorders.

54% of sufferers with mental illness do not seek treatment [1], which is only compounded by the delay in treatment due to problems with detection, social stigma and accurate diagnosis.

Individuals with mental illness accessing treatment are half that of people seeking treatment with physical disorders [11].It’s time to raise awareness for mental health.

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References

1. Australian Institute of Health and Welfare. (2014). Australia’s Health 2014. AIHW: Canberra.
2. World Health Organisation. (2008). The global burden of disease: 2004 update.
3. Australian Bureau of Statistics. (2009). National Survey of Mental Health and Wellbeing: Summary of Results, 4326.0, 2007. ABS: Canberra.
4. Kitchener, B.A. and Jorm, A.F. (2009). Youth Mental Health First Aid: A manual for adults assisting youth. ORYGEN Research Centre, Melbourne.
5. Ivancic, L., Perrens, B., Fildes, J., Perry, Y. and Christensen, H. (2014). Youth Mental Health Report, June 2014. Mission Australia and Black Dog Institute, Sydney.
6. The Australian Senate. (2010). The Hidden Toll: Suicide in Australia Report of the Senate Community Affairs References Committee. Commonwealth of Australia, Canberra.
7. http://www.aihw.gov.au/deaths/causes-of- death
8. Australian Bureau of Statistic. (2012). Australian Health Survey: First Results. ABS, Canberra.
9. National Mental Health Commission. (2013). A Contributing Life, the 2013 National Report Card on Mental Health and Suicide Prevention. NMHC, Sydney.
10. Department of Health and Ageing. (2013). National Mental Health Report 2013: tracking progress of mental health reform in Australia 1993 – 2011. Commonwealth of Australia, Canberra.
11. Commonwealth of Australia. (2010). National Mental Health Report 2010. Canberra, Australia.

PMS is characterised by a collection of physical and emotional symptoms that occur in the day before menstruation.

(Awanish Kumar Pandey, et al. 2013) indicated that 100% of girls tested showed a prevalence of at least one symptom of PMS, with 42.5% showing more than five symptoms.

Some of the most common psychological symptoms ranged from:

• Lethargy (83%)
• Anger and hypersomnia (74%)
• Anxiety (68.5%)
• Feeling overwhelmed (62.5%)
• Hopelessness (50%)
• Difficulty in concentrating (33.5%)
• Tearfulness (26.5%)
• Insomnia (26%)

Some of the most common physical symptoms ranged from:

• Joint or muscle pain (77.5%)
• Headaches (67%)
• Weight gain (58%)
• Backache (57.5%)
• Bloating (41%)
• Breast tenderness (31%)
• Acne (*16.5%)

*16.5% may seem low when compared with some of the other figures mentioned above, however, this still equates to 1/6 women suffering from acne every single month around their menstruation.

The conventional approach for addressing PMS uses SSRI’s, which numbs the individual along with increasing the likelihood of suicide ideation, risks post-SSRI-sexual-dysfunction and depletes melatonin.

This complex condition likely has multiple causes, with fluctuations in hormone levels and nutritional deficiencies playing key roles.

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OESTROGEN

One of the possible reasons for PMS has been associated with the excess of oestrogen relative to progesterone.

High oestrogen has also been found to increase thyroid-binding-globulin, which will reduce the activity of the thyroid hormones, further leading to apathy and a lack of energy. Ensuring oestrogen’s efficient metabolism through the correct pathways and supporting elimination from the body is paramount.

In short, this requires a range of nutrients from cruciferous vegetables, flaxseed and possibly grapefruit (grapefruit does have the ability to inhibit CYP3A4 enzyme which will decrease the metabolism of medication. Therefore grapefruit should be avoided to prevent medical complications).

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PROGESTERONE

Progesterone is also at its lowest during the time of PMS. Progesterone acts on GABA receptors in the brain to produce a calming effect along with supporting thyroid conversion, thus assisting with energy.

The consumption of Wild Yams supports progesterone.

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MAGNESIUM

Magnesium deficiencies may be causing or aggravating symptoms of PMS. Magnesium is essential for nerve, muscle function and the ability for the muscles to relax, all of which can be affected in PMS. (Iran J Nurs Midwifery Res. 2010 Dec).

A decrease of 12.42% in serum magnesium levels have been found in the follicular phase when compared to the menstruation with magnesium levels elevating a further 7% in the luteal phase. These fluctuations portray the role of magnesium in accordance with menstruation. Magnesium can be obtained through the consumption of dark chocolate or almonds.

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IRON

In a meta-analysis, eating an iron-rich diet was linked to a 31% lower risk of developing premenstrual syndrome (Am J Epidemiol. 2013 May). Iron will be depleted during menses, thus further depleting levels. Iron is essential for energy regulation, along with being an essential a cofactor for the enzyme tryptophan hydroxylase, which catalyses the conversion of tryptophan into 5-hydroxytryptophan, a precursor for serotonin (the neurotransmitter associated with mood and happiness).

Iron obtained from plants is likely to have reduced bioavailability within the body. It is often accompanied by phytic acid and oxolates, both of which bind with the iron to prevent absorption.

Another factor to take into account when seeking to optimise iron levels within the body is stomach acid (HCl). HCl is essential to break iron down from food for assimilation within the body.

One can complete the baking soda challenge test for indication of whether their HCl is low or not, by drinking 250ml of water mixed with 1/4tsp of baking soda first thing in the morning. If the individual belches after the 3-minute mark, this would correlate to low HCl and therefore a likelihood that the individual will have poor digestion and assimilation of iron within their body.

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ZINC

Women have a 24%–29% lower risk of PMS when in the top 2 quintiles of zinc to copper ratios (Am J Clin Nutr. 1995). Zinc deficiency is associated with depression while copper up-regulates the CYP19A1 enzyme, which leads to aromatisation of androgens to oestrogen (estradiol) while enhancing estradiol binding affinity to the oestrogen receptors, which amplifies its action.

Below are my preferred dietary sources of zinc per 100g:

• Oysters – 61mg
• Beef – 11mg
• Hemp Seeds – 10mg

Zinc is another micronutrient which requires HCl for its assimilation, therefore assessing HCl status could also correlate with the potential zinc status within the individual.

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VITAMIN B6

The effectiveness of Vitamin B6 in the treatment of PMS dates back over 40 years. Results were noted such as ‘significant decreases in all symptoms’ (Goei and Abraham, 1983), ’70% reporting good or partial response’ (Brush, 1988) and an ‘improvement in 63% of patients on pyridoxine’ (Day, 1979). The dose used within these studies ranged from 40-200mg (with possible risk of toxicity at 200mg).

Only one patient of the 940 participating in these trials indicated the presence of any side effects that could be attributed to the neuropathy associated with pyridoxine toxicity (London RS, et al. 1991).

Obtaining this level of Vitamin B6 effectively through food will be extremely difficult as these dosages are 29-115 times that of the recommended daily allowance.

Below are my preferred dietary sources of Vitamin B6 per 100g:

• Organic liver – 0.6mg
• Pistachios – 1.7mg
• Salmon – 0.9mg

Above is just an example of how proper nutrition can support and mitigate against PMS.

In a meta-analysis assessing the mineral intake of approximately 3,000 women. It found that eating an iron-rich diet (20mg per day) was linked to a 30-40% lower risk of developing premenstrual syndrome when compared to the lowest intake of iron (around 10mg per day) (Am J Epidemiol. 2013 May).

Menstruating women lose around 40% more iron per day when compared to men, with some studies stating how heavy menstrual bleeding is one of the leading causes of anemia in the developed world (Liu Z, et al. 2007).

The National Health and Nutrition Examination Survey indicates that 12-16% of non-pregnant women (aged 16-49 years) have iron deficiency, with 2-4% having anemia.

Increasing iron intake through diet and supplementation for two months has been shown to reduce PMS symptoms considerably in all anemic women (Mitesh Sinha et al. 2013).