Sadness, grief or reactive depression can occur in M.E. and other serious diseases as a result of the severe restrictions on daily living and basic communication, the extreme loss of quality of life, uncertainty or despair over welfare benefits and the money needed to support basic living, as well as the lack of acceptance from society or family.
Feelings of sadness and grief are NOT medical problems that need to be treated, they are normal and healthy reactions to traumatic events. Where feelings of sadness start to become severe and have a large impact on daily life, or there are thoughts of suicide, the problem may become what is known as reactive depression; depression caused by life events (and which is not natural or endogenous).
Depression and anxiety have many causes and how well any treatment will work depends on the actual cause of symptoms. ANY ‘one-size-fits-all’ approach is doomed to failure, for the majority of people.
It is probably a good idea to start with the safest and least risky approach, which would be the nutritional approach. Relaxation, mediation and breathing exercises can also be helpful, particularly when combined with a nutritional approach. Maintaining relationships with friends and family and talking to those in a similar situation to you is also very important.
The nutritional approach to treating depression and anxiety
Depression and anxiety can also occur in M.E., as well as the general population and those with other diseases, due to a lack of certain nutrients. Severe illnesses deplete the body of certain vitamins and minerals and enzymes etc. and increase the daily requirement of these substances. The brain is far more sensitive to biochemical imbalances and nutritional deficiencies than any other organ of the body. Lack of nutrients and an excess of ‘anti-nutrients’ such as lead or chemical additives can cause many different mental health symptoms.
For some people, symptoms of anxiety and depression completely resolve once magnesium deficiency or vitamin C deficiency is treated. The same may be true of other substances such as the B vitamins as well.
It is also important to be aware that while there may be solid reasons for feelings of depression or anxiety etc. due to life circumstances, nutritional deficiencies and issues of toxicity could be making these symptoms far worse than they would otherwise be. Correcting these issues may make some symptoms much milder and/or make stressful events easier to cope with and so on.
The first step in trying to improve symptoms of depression and anxiety through nutrition is to clean up the diet. Following the dietary guidelines recommended on HFME can improve symptoms of depression and anxiety, in several different ways. In short;
Remove sugar and processed foods from the diet (and anything else you know you react to). Most important of all, particularly if you have anxiety problems, is to strictly avoid sugar. There is a direct link between mood and blood sugar balance.
Eat fat, protein and low GI and GL carbohydrates, lots of nutritious whole foods that do not contain additives and preservatives and so on. If possible, buy organic food.
Eliminate (or at least reduce) caffeine. Caffeine raises insulin levels in a similar way to sugar.
Eliminate (or at least reduce) alcohol. Alcohol is a depressant and also depletes your body of a number of nutrients.
Eliminating wheat and dairy may or may not be necessary. The only way to be sure is to stop eating these foods for a month and see if you feel better.
Eat every 3 – 4 hours to prevent blood sugar levels from becoming low. Make sure meals contains some fat, protein and carbohydrate as eating meals made up almost entirely of carbohydrates can lead to blood sugar highs and lows and mood swings and anxiety.
For some, this change of diet may be enough to resolve symptoms of depression or anxiety.
Some deficiencies may not be able to be resolved through diet alone, however, and may require supplementation.
Starting a general supplement program which covers all the basics is a very good idea before starting to take any supplement at higher doses.
Some of the most common supplements that can help to treat or improve depression and anxiety including the following:
Magnesium 800 - 1000 mg or more (depending on individual need), in 4 divided doses. Transdermal magnesium may be a better choice for depression as it also boosts DHEA levels (and so all the hormones that are made from DHEA) which can also improve depression in some people. Over 80% of people in the western world are low in magnesium. Low magnesium levels are the sole cause of depression, restlessness, anxiety and panic attacks in a significant percentage of people.
A good quality multivitamin and mineral supplement or B complex product containing adequate amounts of each of the B vitamins. Vitamin B1 50 – 100 mg, B2 50 – 100 mg, B3/Niacin 500mg (subclinical deficiencies of vitamin B3 can cause symptoms of agitation and anxiety), B5 100 mg + (this vitamin is needed for hormone formation and the uptake of amino acids and the brain chemical acetylcholine, which combine to prevent certain types of depression), B6 50 – 100 mg (vitamin B6 is needed in the manufacture of serotonin, melatonin and dopamine), B12 500mcg +, folate 800 mcg + (folate is necessary for the production of SAM (S-adenosyl methionine), choline, inositol 1 – 2 g (at this dose, inositol may improve depression and anxiety and sleep).
If you do not feel a noticeable positive effect from basic B vitamin supplementation within 2 – 4 weeks, buy a bottle of coenzymated sublingual B complex to try at a dose of 1 daily (or 2 daily to start with). This product may be essential if your body does not coenzymate B vitamins very well. (This can occur where illness is severe).
Make sure to take extra vitamin B6 if you are also taking the contraceptive pill or hormonal replacement therapy. These drugs (as do many or even all drugs) deplete vitamin B6.
Vitamin C, minimum dose 1 – 2 grams daily, although 5 – 10 g or more may be needed by some people to improve symptoms of depression (and other symptoms known to be improved with vitamin C). One of the most common effects of inadequate vitamin C is depression.
Vitamin C plays an important role in the production of serotonin, it catalyzes the manufacturing of serotonin. Serotonin is a brain chemical, a neurotransmitter, responsible for your mood. Vitamin C is therefore one of the valuable natural antidepressants for patients with depression associated with low level of serotonin. Andrew W. Saul PhD explains how to ‘make your own norepinephrine’ as follows,
A depletion of the neurotransmitter called norepinephrine may result in poor memory, loss of alertness, and clinical depression. The chain of chemical events in the body resulting in this substance is: L-phenylalanine (from protein foods) -> L-tyrosine (made in the liver) -> dopa -> dopamine -> norepinephrine -> epinephrine.
This process looks complex but actually is readily accomplished, particularly if the body has plenty of vitamin C. Since one's dietary supply of the first ingredient, L-phenylalanine, is usually adequate, it is more likely to be a shortage of vitamin C that limits production of norepinephrine. Physicians giving large doses of vitamin C have had striking success in reversing depression. It is a remarkably safe and inexpensive approach to try.
Tryptophan 500 - 2,000 mg daily from supplements, or from foods such as lentils, dried peas, navy, pinto, red kidney or soy beans, tahini, brazil nuts, cashews, hazelnuts, peanuts, pumpkin seeds, sesame seeds, eggs and poultry and other fresh meats, including organ meats. (Note that trytophan is restricted for sale in some countries, including Australia.) Note that tryptophan supplements may not be well tolerated in M.E., along with 5-HTP. Andrew W. Saul PhD says, ‘Tryptophan is broken down into anxiety-reducing, snooze-inducing niacin. Even more important, tryptophan is also made into serotonin, one of your body's most important neurotransmitters. Serotonin is responsible for feelings of well-being and mellowness.’
Lecithin 2.5 – 5 g. Andrew W. Saul PhD explains how to ‘make your own acetylcholine’ as follows,
Acetylcholine is the end neurotransmitter of your parasympathetic nerve system. This means that, among other things, it facilitates good digestion, deeper breathing, and slower heart rate. You may perceive its effect as "relaxation." Your body will make its own acetylcholine from choline. Choline is available in the diet as phosphatidyl choline, found in lecithin. Lecithin is found in egg yolks and most soy products. Three tablespoons daily of soya lecithin granules provide about five grams (5,000 milligrams) of phosphatidyl choline. Long-term use of this amount is favorably mentioned in The Lancet, February 9, 1980. Lecithin supplementation has no known harmful effects whatsoever. In fact, your brain by dry weight is almost one-third lecithin!
Note that lecithin also contains choline and inositol and so the stated amounts of these supplements may not be necessary when taking lecithin.
Chromium 400 - 600 mcg. Chromium may be helpful in treating ‘atypical’ depression.
L carnitine 1 – 2 g. L carnitine may alleviate depression in some patients, at this dose. Acetyl L carnitine may also be helpful at a dose of 500 mg (although it may increase neurological overload in some patients).
Armour thyroid. Correcting a thyroid deficiency can improve symptoms of depression in some cases.
DHA and EPA fatty acids from fish oil, 1 – 2 grams or more. Researchers have found that omega 3 fatty acids (DHA and EPA) raised levels of the important neurotransmitter serotonin, in the brain. Omega 3 fatty acids have been shown to improve anxiety, sleeping problems, sadness, decreased sexual desire and suicidal tendencies. A month or more is needed to see the full effects.
Vitamin D, at the dose indicated by testing. Low vitamin D levels can cause depression. Vitamin D has profound effects on the brain, including the neurotransmitters involved in depression and seasonal affective disorder.
Zinc 30 – 60 mg. When zinc is low, copper in the body can increase to toxic levels, resulting in paranoia and fearfulness.
Potassium depletion is frequently associated with depression and tearfulness.
Manganese is needed for proper use of vitamins B and C. A deficiency may contribute to depression stemming from low levels of the neurotransmitters serotonin and norepinephrine. Manganese also helps prevent hypoglycaemic mood swings (as does chromium).
A safer alternative to valium is niacin, according to Andrew W. Saul PhD. He writes that,
Niacin/vitamin B-3 is so effective against actual psychoses that half of all mental ward inmates in the South were able to be released once a depression-era deficiency of this vitamin was corrected. Niacin in appropriate doses acts as a natural tranquilizer and induces relaxation or sleep. It is non-addictive, cheap, and safer than any pharmaceutical product. Dosage varies with condition. The best author on the subject is Abram Hoffer, M.D., whose experience dates back to the early 1950's. He routinely gave at least as much vitamin C as he did niacin.
Patients may wish to substitute flush-free niacin for regular niacin if they do not wish to experience the ‘niacin flush.’
5 Hydroxytryptophan (5-HTP) is an alternative to the traditional antidepressants used to treat unipolar depression. It comes with its own cautions and warnings, and is not suitable for long-term use but may still be a safer alternative to prescription antidepressant drugs. Patrick Holford explains that, ‘In play-off studies between 5-HTP and SSRI anti-depressants, 5-HTP comes out slightly better.’
See the ‘Important extra treatment cautions and warnings relevant to M.E.’ section for more information about 5-HTP and before taking 5-HTP.
SAMe, at the dosage recommended on the bottle. (SAMe may help some M.E. patients with depression but this supplement may not help others and may be poorly tolerated, at least in part as it can improve the process of methylation. SAMe can cause the same severe problems in M.E. as supplementation with cysteine. For this reason, many of the other supplements listed here and probably a better first choice for M.E. patients and others. This supplement should be started at a very low dose in M.E., perhaps 1/10th of a tablet.) SAMe should not be taken by those diagnosed with bipolar disorder.
The following herbs may also be useful in reducing symptoms of depression or anxiety:
St John’s Wort, 300mg x 3. St John’s Wort works in a similar fashion as a SSRI in that it inhibits serotonin reuptake. Try to find 300mg capsule of standardized extract that contains 0.3% hypericin and 5% hyperforin. Expect to wait 6 weeks to see effects. Note that St John’s Wort should NOT be taken with antidepressant drugs. St. John’s Wort may increase sedation when narcotics are administered during surgery.
Ashwagandha is an herb that has many effects, including acting as an antidepressant.
Herbs such as chamomile and catnip make a soothing tea.
Note that this information on nutritional and herbal treatments is in no way specific to M.E. or any other distinct disease and may just as easily be used as a reference by those with other diseases than M.E. or for whom depression or anxiety is their only health problem.
For information on the different forms, dosage, cautions and so on for each vitamin or mineral etc. mentioned here, please see the other website pages. Do not start any treatment at the full dose right away (or on it’s own) and do not start any new treatment without reading this information first.
Testing for deficiencies and problems which may contribute to or cause symptoms of anxiety or depression
Some of the nutritional deficiencies that can cause symptoms of depression or anxiety can in fact be tested for.
The problem is that there are many different tests and so having lots of these tests may not be practical economically. The website www.mentalhealthproject.com may be useful here as it offers free questionnaires which may help pinpoint the causes of symptoms and let you know which symptoms are linked with which deficiency.
(Even so, it may still be far simpler and cheaper to try taking some fish oil for several months rather than to have levels of essential fatty acids tested, and so on. This is particularly relevant when you are talking about all those vitamins and minerals etc. which are relatively inexpensive and essential to good health anyway. It makes more sense just to take them and see how you feel than to have expensive testing.)
Mental health problems can be caused by or worsened by
A deficiency of essential fatty acids. A deficiency of essential fatty acids is treated by supplementing the appropriate essential fatty acids (eg. fish oil)
Blood sugar imbalance. Blood sugar imbalance or poor glucose tolerance is treated in various ways, but what is essential is a low sugar diet, and a balance between low GI and GL carbohydrates, fat and protein in the diet. Chromium supplementation may also be helpful in keeping blood sugar levels stable.
Underactive or overactive thyroid. Underactive thyroid is treated with thyroid replacement therapy (eg, Armour thyroid.)
Adrenal issues. Supplementation with cortisone may be necessary to treat adrenal insufficiency.
Hormonal issues. Some hormonal issued, such as PCOS, are treatable with diet.
Food and chemical (and drug) allergies and intolerances. Food and chemical allergies and intolerances are managed via avoidance of problematic foods and chemicals.
Drug-side effects. For example, beta blockers affect the CNS and can cause malaise and depression. Some drugs may have to be discontinued (with medical assistance).
Heavy metal toxicity. Heavy metal toxicity is improved by first avoiding further heavy metal exposure, and then a detoxification regime. (Dental fillings containing mercury can worsen depression.)
High homocysteine levels. High homocysteine levels are brought down with adequate B vitamins and zinc.
Low serotonin levels. May be treated with 5-HTP.
Relevant tests include:
Essential fatty acid testing
Glucose tolerance testing
Thyroid function tests
Adrenal function tests
Various tests of hormone levels
Homocysteine levels testing
Neurotransmittter screening test
Platelet serotonin test
For more information on testing for causes of mental health issues, see the ‘The NEW optimum nutrition for the mind’ book by Patrick Holford and his www.mentalhealthproject.com website.
A combination of dietary changes, vitamins, herbs and so on may be necessary to successfully treat symptoms of depression and anxiety. Relaxation and mediation exercises may also be helpful.
For the best results, an individualised nutrition and supplementation plan should be created in partnership with a qualified holistic practitioner. Ideally, this practitioner would also be the patient’s doctor.
The best results are also achieved by following a comprehensive nutrition and supplementation plan, rather than only taking a small number of supplements, and by doing as much reading as possible before starting any new treatment
For some patients, some form of talking therapy may also be useful or even vital. In general, patients themselves are most likely the best judge of whether or not there are serious psychological issues that need to be dealt with and if counselling or psychotherapy is necessary. These issues may have occurred many years prior to M.E. or other disease and be entirely unrelated to the disease, or may involve problems coping with poor treatment by friends and family etc. since becoming ill or coping with the severe limitations of the disease itself.
For more information on this topic, please see the reference list for this paper. If depression or anxiety is a serious issue for you, perhaps you may consider buying (or borrowing) one or more of the books listed.
All the very best to everyone reading this paper.
Additional notes on this topic
1. The best way to improve sadness and grief caused by loss of quality of life in M.E. is of course to lessen the severity of the disease overall. See the other HHH site pages for more information on this important topic.
For information and tips on coping with M.E. emotionally, reducing stress (and issues around finding a good counsellor or therapist, where one is desired) see the Coping with M.E. Emotionally paper on HFME.
2. Prescription antidepressant drugs are very often poorly tolerated by people with M.E. Where depression is severe and antidepressants drugs may be a necessary last resort, the initial dosage used should always be very small (1/10th of a normal dose or less) but even at this dosage many people with M.E. cannot tolerate these drugs at all. Some particular antidepressants may cause other serious problems: Doxepin is known to cause heart problems (which is particularly concerning considering the well known cardiac issues in M.E.) and Serzone (a drug which has been taken off the market in some countries but not others) is linked with liver failure. Prozac contains a lot of toxic fluoride and has been described as a product that act as a fertiliser for cancer. See the Real depression help website to read about serious cardiac and other side effects of certain antidepressants drugs.
M.E. patients whose doctors recommended antidepressants as a treatment for M.E. (rather than a treatment for depression, or prescribe them where there is no anxiety or depression) should NOT accept this advice. Antidepressant drugs are in no way a useful treatment for M.E. and can and often do cause severe relapse.
(On a personal, and anecdotal note, it is difficult to put into words how terrible it is to be so ill with M.E. and to have so many horrific physical symptoms suddenly, and then to be given a prescription antidepressant drug – when you are NOT depressed. It can very quickly make life utterly miserable, as the ability to look on the light side of things, to laugh and to feel happiness and joy, and so on, is taken away. When you are so ill that all you have left is your mind, your humour and your personality...to have access to this taken away for weeks or months by an inappropriate drug is appalling. What makes this even worse is that the drug has no possible benefit; the risk of physical or emotional fallout is enormous, and the risk of benefits is zero! Not a good deal or a sensible risk by anyone’s standards. If you know you are not depressed, do not take antidepressant drugs even at the urging of your (M.E. ignorant) doctor. Stand up for yourself and what you know about your own condition.)
3. It should NOT be assumed that all or even most M.E. patients are suffering with depression. This is not the case.
The rate of clinical depression seen in M.E. is similar to, and not higher than, that seen in comparable illnesses such as rheumatoid arthritis. (Of course, depression is a common disease, and it does not make you immune from other diseases. So some patients with depression will also end up having other conditions as well, over time. This includes M.E., plus MS and Parkinson’s and all other diseases.)
Although a minority of M.E. patients will have a clinical depression, more often some patients are instead dealing with natural and expected levels of grief and sadness for what they have lost. If these feelings are present, they are not evidence of a psychiatric disease but simply a normal and healthy reaction to an extremely distressing life experience and extreme levels of physical suffering. The only ‘treatment’ needed is an improvement in the severity of the condition, and in many cases probably also greater levels of appropriate medical, financial and/or social support. As one long-time M.E. sufferer explained, ‘The desperation one gets periodically from being so ill is not at all the same thing as 'clinical depression'. Give me an even somewhat better day physically – and my mood improves quickly and dramatically!’
4. Exercise is highly recommended for non-M.E. patients in the treatment or management of depression, and for good reason. In M.E., however, any level of activity over an individual’s limits can only worsen all symptoms. It will NOT have an antidepressant effect where even minor relapse or a worsening of symptoms is caused. There are no exceptions to this rule.
The Doctoryourself.com article on depression
The Doctoryourself.com article on anxiety attacks
The www.mentalhealthproject.com website
The Real depression help.com website
Depression cured at last by Dr Sherry Rogers.
The NEW optimum nutrition bible by Patrick Holford
The NEW optimum nutrition for the mind by Patrick Holford
Fire your doctor! : how to be independently healthy and Doctor yourself : natural healing that works by Andrew W. Saul PhD
Anxiety: Orthomolecular Diagnosis and Treatment by Jonathan Prousky and Abram Hoffer
Physician's Handbook on Orthomolecular Medicine by Roger J. Williams and Dwight K. Kalita
Food is better medicine than drugs by Patrick Holford and Jerome Burne
The schizophrenias: Ours to conquer?
Note that the aim of this site is to provide a starting point for health and healing research for ill people; especially very overwhelmed and disabled ill people. This site provides recommendations, summaries and reviews of books but is not meant to be a replacement for actually reading some of these wonderful health books if the reader is at all well enough to do so. (Plus getting individualised advice from a doctor that is also an orthomolecular medicine expert if possible). There is no substitute for reading as many of these books as you can. The HHH site can only really hint at their full brilliance. The amount of insight, scientific references, logic, intelligence, compassion and experience in the recommended books will most likely amaze you. HHH aims to encourage people to do their own reading and learning, and to always make up their own minds. All content copyright Jodi Bassett 2006 - 2014.