Treating depression without drugs using natural remedies

Depression isn’t what we thought it was

© PeterSmithUK.com

The new understanding of what causes depression

Since the early 2000 we have known that you can induce depression in humans and animals without adding any psychological stress or distress simply by inducing inflammation in the brain.  At the time this was a very surprising finding it seemed to overturn everything we understood, we know psychological stress and trauma can cause depression and psychological treatments can be effective as can treating neurotransmitters.

So how does inflammation cause depression?

Firstly inflammation directly disrupts neurotransmitter production, with regard to serotonin inflammation not only diminishes serotonin production but it also changes tryptophan (the amino acid that serotonin is made from) into something poisonous to the brain called quinolinic acid.

Secondly persistently elevated inflammation in the brain breaks down synaptic connections in parts of the brain that control our thinking and mood (the cortex and the limbic system). The old model of depression was that low neurotransmitter levels in the synapses cause depression, the new model is that depression is not just low levels of neurotransmitter in the synapses, it’s an actual lack of synapses left to carry the neurotransmitters in the first place.

Why does psychological stress cause depression?

START… where psychological distress and trauma fits in persistent psychological distress causes persistent activation of stress responses in our body and one aspect of physical stress responses as increased inflammation. Let me say that again: psychological distress activates stress responses which increase levels of inflammation in the body and if these persist for too long and our brain is unable to protect itself from the elevated inflammation in our brain breaks down and we become depressed.

It’s a mistake to think that depression is the actual psychological stress and trauma if you think about it many people have a lot psychological distress and trauma but they don’t become depressed, in their case their resiliency to stress, their ability to manage stress and the neuroplastic ability of the brain can withstand the stress so they don’t get significant disruption of neurotransmitters and a loss of synapses. Conversely in other people it takes very little psychological distress to overwhelm the brains neuroplasticity and cause depression.

Psychological distress is a cause or risk factor for depression in a similar way to the way air pollution is a cause or risk factor for asthma, we don’t say that air pollution is asthma, and it’s a mistake to say that psychological distress is depression.  Psychological distress may be the most common cause or risk factor for depression is not the only one; remember that we can induce depression by ramping up inflammation without any increased psychological distress.

The nurture versus nature debate of depression is out of date

We know from human twin and animal studies that some individuals are genetically predisposed to be more vulnerable to psychological stress and trauma causing depression.

Superimposed on our genetics are epigenetic factors that change the expression of our genes, for example epigenetic factors can change the genes that regulate the amount of serotonin in our synapses (serotonin transporter levels). Epigenetic influences can be superimposed on our genes during early life experiences, during the womb, on our parents and even our grandparents going back several generations DNA from experiences they had in their life, early life and when they were in the womb! This new understanding of epigenetic’s has made the old simplistic way of thinking about nurture versus nature as basically biology versus psychology so out of date.

We also know that early exposure to prolonged stress or trauma can cause neuroplastic changes in structures in the brain that predispose people to an increased vulnerability to stress induced depressive breakdown and that these neuroplastic changes and increased vulnerability can persist throughout life. These are biological (nature) changes brought about by psychological experiences (nurture) but they then persist and make us more vulnerable to biological breakdown from external psychological stresses.

The good news is that armed with this new understanding we can combat this vulnerability with intensive brain training and other measures to improve our resiliency to the psychological stress and trauma that life presents us with from time to time.

In addition to genetics and early life experiences we also know that once you’ve had one bout of depression it changes the brain in a way that makes it more vulnerable to having depression again so unfortunately people can end up with relaxing remitting depression; but yet again susceptibility of an individuals brain to be permanently changed by one bout of depression will vary according to the genetics and other environmental forces such as the diet.

Don’t let any of this inflammation depressed you! I believe that with the new understanding we can target the changes in the brain and protect or immunise ourselves so to speak from relapsing back into depression. For example one of the structural changes caused by early life exposure to prolonged stress or trauma is enlargement of the amygdala but brain scans have shown that we can shrink the amygdala with as little as 50 hours of the right type of meditation brain training, we can also prevent unnecessary elevated inflammation with a healthy anti-inflammation diet, there are inflammation controlling supplements,  there are brain training exercises we can do to dampen down overactivity in  neurological pathways involved in stress and inflammation (the HPA axis), and dampen down overactivity in the default mode network, there are even specific types of bacteria we can grow in our large intestines at protect us from stress induced breakdowns.

The understanding that depression is actual physical changes in the brain

… Our stress physiology and this causes our inflammatory responses to be persistently elevated.

So depression is not psychological distress, psychological distress causes inflammation which causes disruption of neurotransmitters and the breakdown of synapses and that’s what depression. Another way of saying this is psychological distress is a risk factor or cause of depression in a similar way to the way air pollution is a cause or risk factor

…is caused by damaging forces  occurs when damaging forces from inflammation and overwhelmed our brains ability to maintain its structures inflammation and other elements overwhelm our brain causing excessive breakdown of synaptic connections

and disruption neurotransmitter production.

… This loss of connections occurs when inflammation and other stressors causes synapses to be lost more quickly than our brains (neuroplastic) ability to repair and replace them.

The production a depressive breakdown occurs when our brains neuroplastic ability to maintain and protect itself is overwhelmed by destructive elements that you cause a loss of (and dysregulation) of synaptic connections; chief among the destructive elements is inflammation  The new model explains … and how psychological distress, instead it unites and brings them together for the first time and offers us a revolutionary new way of treating depression.

Neurotransmitters are still an important target for depression treatment but targeting the right neurotransmitter system is critically important see: Which Neurotransmitter Is Involved in Your Depression? Serotonin, Dopamine, PEA, Endocannabinoid.

MOVE THIS TO A NEW PAGE AND EXPAND

The loss of synaptic connections in the depressed brain occurs when our brains neuroplastic ability to protect and maintain its structures becomes overwhelmed by destructive elements. There are many destructive elements chief among them being inflammation and this can come from psychological stress. Prolonged and extreme stress cause overactivity in the bodies (HPA) stress physiology, resulting in cortisol-insensitivity which causes inflammation in the brain.

Psychological stress and trauma can cause depression in susceptible people but they are not what depression actually is; depression can involve low levels of and dopamine activity but what’s causing the neurotransmitter imbalances in the first place?

This is a much deeper understanding of the root causes depression and points us to completely new treatment approaches: we can combat depression firstly by eradicating sources of inflammation and it turns out that psychological stress is top of the list of causes of inflammation, and secondly we can boost the brains protective and regenerating or neuroplasticity abilities.

In 2012 I developed a new treatment approach intended to reduce neuron damage from inflammation and other sources whilst at the same time boosting neuroplasticity, initially I developed this approach regrow lost connections in my own brain and then adapted it to treat depression and help bring bipolar disorder, OCD and schizophrenia under control; I believe this new treatment approach significantly improves outcomes and quality of life.

Important note although the science that inflammation and neuroplasticity are involved in mental health problems all the treatment methods I use are so-called alternative and not conventional mainstream medical practices. I am not a medical doctor, I studied neurophysiology and pharmacology at university then subsequently trained in so-called alternative functional naturopathic nutritional and herbal medicine, I have been practising these techniques since 1988.

The loss of connections seen in the depressed brain occurs when damaging forces from inflammation, psychological stress and other elements overwhelms the brains ability to protect and regenerate itself.

We now know that inflammation is the primary destructive force causing the changes in the brain in most cases of depression

…when we boost low neurotransmitter levels with drugs or natural remedies it may help but it is not treating the underlying root cause of the low neurotransmitter levels in the first place.

The v disrupting neurotransmitters and stripping out synapses is elevated inflammation in the brain.

The old models that depression is either neurotransmitter deficiencies or all in the mind are now simply out of date

In 2003 it was established that you can create major depression in humans depressive -like behaviour and animals just by inducing inflammation in the brain without any psychological stress involvement at all; this overturns the theory of depression is all in the mind but as I’ll explain below it turns out psychological stress can create inflammation in the brain by altering stress hormones and gut health.

The revolutionary new understanding is that depression occurs when destructive forces principally inflammation become sufficiently strong to overwhelm our brains ability to protect and regenerate itself. This results in the synaptic connections in the parts of the brain that control our mood and thinking breaking down more quickly than they can be replace. Brain scans consistently show a loss of size in the hippocampus and cortex, but don’t let reading this depressed you further because brain scans have also shown that the brain has the capacity to regrow and regenerate. Since 2012 I’ve been developing treatment protocols to stimulate regeneration in the depressed and bipolar brain by stimulating neuroplasticity and combating the underlying causes of inflammation and other destructive forces. This is a truly revolutionary new approach to treating depression and other mental health problems; the pharmaceutical industry is currently working on a new generation of antidepressants based on these new understandings, but I believe we don’t have to wait and that we can start applying this breakthrough new science today using specific natural remedies, diets, exercises et cetera.

This new understanding means that depression is not just a deficiency of neurotransmitters it is also a lack of synapses ‘left’ to hold and transmit neurotransmitters and furthermore the treatment should focus on re-growing lost synaptic connections by eliminating inflammation and boosting neuroplasticity, not just trying to increase neurotransmitter levels in the remaining synapses whether with drugs or natural remedies.

What’s interesting is there’s a theory that antidepressant drugs don’t just work by boosting neurotransmitter levels but that they also work because they are anti-inflammatories and stimulate neuroplasticity, this new model explains why antidepressants take several weeks to work.

Neurotransmitters are still hugely important in depression

The new understanding does not diminish the importance of neurotransmitters in depression, because in addition to stripping out synaptic connections inflammation also directly disrupts neurotransmitter activity. Inflammation explains what causes neurotransmitters to go out or balance in a way we have never had before; it actually explains the root causes of depression and opens up new treatment possibilities.

The new understanding also means that depression is not just intense psychological distress or trauma. It’s a mistake to confuse a risk factor that can cause a condition with the condition itself. Psychological distress and trauma activate our immune system to defend us from the threat, our immune system releases inflammatory cytokines which then alter neurotransmitters, brain structure and function, and this changes the psychological stress and trauma into depressive illness. Not everyone that has psychological distress and trauma gets depression and not everyone with depression has psychological distress and trauma, you can develop depression just from increasing inflammation in the brain. If you still think that depression is psychological distress and trauma then you need to update your understanding.

Psychological distress and trauma is still hugely for depression

The research appears to suggest that psychological stress and trauma may be the leading cause of the inflammation that causes depression. Moreover, numerous studies show that early life exposure to prolonged stress and trauma permanently change the brain enlarging the amygdala and other things leading to a lifelong increased susceptibility to depression.

The good news is that we can do a lot to change the way our brain manages stress and traumatic memories not only to help us recover from a current bout of depression but also to reduce the chances of relapsing. In my practice I use brain training exercises and meditation exercises to teach the brain and contemporary psychotherapy

Depression also involves overactivity in specific neuro-circuits

Brain scans have shown that in the depressed brain there is overactivity in a circuit called the default mode network (DMN). The DMN gathers feelings of danger, distress or impending doom from the amygdala, associates these feelings with detailed unhappy traumatic and distressing memories stored in the hippocampus and then relays this depressing information forward into our conscious thinking cortex. When the DMN is overactive our mind is excessively bombarded with negative, distressing and pessimistic inflammation. Overactivity in this neuro-circuit distorts our perception how bad things are, past present and future, how bad a person we are, the magnitude of our failures and more; when not completely hallucinating things that aren’t real in schizophrenia

we are, how bad our past was, our future is

This is not like the hallucinations you in schizophrenia, the thoughts and feelings you have in depression may be real but what isn’t real

We can train our brain to dampen down overactivity

Just because we can see that psychological distress and trauma can cause depression and psychotherapy treatments can treat depression this does not mean that psychological distress and trauma are what depression actually is. Confusing the risk factors that can cause a condition with the condition is a mistake; depression is the condition stress and trauma are just risk factors. An analogy is toxic air pollution is a risk factor or causative of agent for asthma but asthma is not air pollution and depression is not stress and trauma.

Psychological stress may be the primary source of inflammation that causes depression

There’s a whole new area of science (Psycho neuro immunology) has revealed that psychological stress causes inflammation in the body in several ways that increases the inflammatory burden on the brain increasing our risk of depression breakdown, in fact it appears psychological stress and trauma may be the leading cause of the inflammation that causes depression.

Psychological stress causes inflammation through several mechanisms: it over produces the stress hormone cortisol via the HPA axis, elevated cortisol production directly causes inflammation in the brain and weakens the gut wall, inflammation has multiple effects on the digestive system and gut brain axis, it reduces activity in the vagus nerve which induces an inflammatory response that attacks the gut wall allowing intestinal bacteria and half digested food to enter the bloodstream which activates more inflammation setting a negative feedback loop, and probably several other mechanisms have yet to discover.

The good news is there is a lot we can do to change stress induced inflammation, in my practice I teach brain training exercises and meditation to train the brain to switch off the stress responses quickly and efficiently, with sufficient brain training you can permanently hardwire new skills into the brain including the ability to switch stress more efficiently.

An analogy is toxic air pollution is a risk factor or causative agent for asthma which can be serious enough to kill people and moving away from the air pollution and stopping smoking can relieve asthma, just like reducing stress can relieve depression.

Also not everyone exposed to air pollution gets asthma just like not everyone exposed to distress and trauma develops depression. Also you can develop asthma and depression without air pollution and without psychological stress or trauma. It was proven in the early 2000’s that you can induce and relieve depression in both humans and laboratory animals without any psychological stress whatsoever just by adding and subtracting inflammation; you can also induce depression traumatic brain injury.

What causes the inflammation that drives depression?

There are about half a dozen common risk factors that drive up the inflammation that can cause depression including:

• psychological stress,
• high blood sugar/insulin resistance and being overweight is a risk factor for insulin resistance, being overweight is also an independent factor that ramps up inflammation in the body,
• pool gut health, a significant source of inflammation can be the overgrowth of bacteria in the small intestines (SIBO) which causes a leaky gut that allows half-digested food molecules and bacteria from the gut to enter the bloodstream triggering inflammation,
• persistent or recurrent infections including sinus/throat infections, dental/gum and SIBO all directly trigger immune inflammation responses and when the body has to fight an infection brain health is sacrificed,
• common easily made dietary mistakes,
• common deficiencies in key nutrients including D3, magnesium, B12 and methylfolate especially if you have the MTHFR gene mutation,
• incidentally lifestyle, smoking et al.

One thing to understand is that these sources of inflammation add together, they are cumulative each one independently contributing, and when the level of inflammation is too high for too long it overwhelms the brains neuroplastic abilities. The good news is you can combat every single one of these and furthermore you can also independently take remedies diet and exercises that boost your innate neuroplasticity (the brains ability to maintain and regenerate itself); this offers a truly new approach to treatment that explains why neurotransmitters have gone out of balance in the first place and the true role of psychological stress and trauma.

The goal in my clinic is to identify and eliminate every possible source of inflammation.

For several decades we knew that there was persistently increased levels of inflammation in depressed brains, but it wasn’t known if one thing caused the other, if it was just a coincidence or if there was some underlying root cause of both the inflammation and depression. By the early 2000’s it was established that the inflammation was the driving force behind the depression and not the other way around. By the end of that decade the science had moved on from just understanding that inflammation cause depression to understanding the mechanism of how inflammation causes depression.

Interestingly it appears that psychological stress and trauma may be the leading cause of the inflammation that causes depression. It’s a mistake to think that psychological stress and distress are depression, or that depression is psychological distress; an analogy is toxic air pollution is a risk factor for asthma but it is not asthma, and psychological distress and trauma are risk factors depression. Depression occurs when our brains’ neuroplasticity is overwhelmed by the accumulation of excessive inflammatory and other destructive forces.

psychological distress and traum and are risk factors depression, depression occurs when our brains neuroplasticity abilities are well, not everyone that suffers from psychological distress and trauma suffers from depression.

There are many possible sources of elevated inflammation in the brain but it appears the most common

Standard treatments for depression target low neurotransmitter with drugs or natural remedies or talk therapies to change our psychology. Boosting neurotransmitters with natural remedies (or drugs) can still be helpful but if you don’t reduce the inflammation in your brain and eliminate the root causes of the inflammation the treatment may is unlikely to to work as well and may not work at all.

Inflammation changes serotonin metabolism (see diagram), instead of making serotonin tryptophan (the amino acid serotonin is made from

it diverts tryptophan, that serotonin is made from, away from serotonin production

If you take the natural remedy tryptophan for example to try to increase your serotonin levels before correcting excessive inflammation the tryptophan supplements will make neurotoxic quinolinic acid and make things worse there’s growing evidence the greater the level of inflammation in your brain the less responsive to antidepressant drugs[i][ii] may be.

Preventing depression relapses

Even if you do recover from your current bout of depression leaving unchecked sources inflammation in your body leaves you vulnerable to relapse because inflammation is the primary driving force that causes depression. Unfortunately a single bout of depression changes thins out the synaptic connections in the hippocampus and cortex and increases connections in the amygdala and default mode network making it easier for your brain to develop depression again when attacked by stress and other sources of inflammation.

The good news is that you can do things to eradicate the root causes of inflammation from your body and mind (yes mind) and follow a healthy anti-inflammation diet etc to immunise yourself

So where does the inflammation that cause depression come from?

but just targeting neurotransmitter levels fails to address the reason the neurotransmitters are out of balance in the first place,

When inflammation and damaging forces overwhelm the brain what happens is synaptic is the underlying cause of depression

Decreasing brain inflammation

In recent years neuroscience has developed a completely new understanding that low-level hidden background inflammation in the brain is a root cause of mental health problems. Elevated inflammation in the brain is universally found in depression, bipolar disorder, OCD, schizophrenia and PTSD; the exception is anxiety. In depression there is clear evidence that the inflammation comes first and causes changes in the brain that resulted depression. In OCD inflammation can trigger first episode. Bipolar disorder (which I have) and schizophrenia are very complex conditions involving more than just inflammation however combating inflammation can be a significant help.

How does brain inflammation cause mental health problems?

Firstly inflammation in the brain disrupts serotonin, dopamine and norepinephrine production, secondly inflammation causes synapses to break down more quickly (the synapses are the places where a neuron releases neurotransmitters to send a signal to the next neuron).

When our synapses break down more quickly than our (neuroplastic) ability to replace and maintain them we lose connections in the brain, in the depressed brain for example there’s a loss of connection in the cortex and limbic system altering (negatively) our thinking and feelings (mood). In other words depression is not just a problem of having too little neurotransmitters in the synapses it’s also having too few synapses left to hold and transmit neurotransmitters. This is a completely new understanding of what causes depression and more importantly it’s led to new ways of treating it.

[i] JAMA Psychiatry. 2013 Jan;70(1):31-41. A randomized controlled trial of the tumor necrosis factor antagonist infliximab for treatment-resistant depression: the role of baseline inflammatory biomarkers. Raison et al PMID: 22945416 PMCID: PMC4015348 DOI: 10.1001/2013.jamapsychiatry.4

[ii] Am J Psychiatry. 2014 Dec 1;171(12):1278-86. doi: 10.1176/appi.ajp.2014.14010094. Epub 2014 Oct 31. An inflammatory biomarker as a differential predictor of outcome of depression treatment with escitalopram and nortriptyline. Uher et al.