Depression: Latest Facts, Causes, Types, Risks, Treatments and Prognosis

Depression is an illness characterized by, among other things, with great sadness, feelings of despair (depressive mood), loss of motivation and decision-making ability, reduced feelings of pleasure, eating and sleeping disorders, suicidal thoughts, and a feeling of worthlessness as an individual.

Depression

In the medical world, the term severe depression is often used to describe this disease. Depression usually occurs in the form of depressive episodes that can last for weeks, months, or even years. Depending on the intensity of the symptoms, depression is classified as mild, moderate, or severe. In the most severe cases, depression can lead to suicide.

Depression affects mood, thoughts, and behavior, but also the body. Depression can manifest itself in the body through back pain, stomach issues, and headaches.

Depression or just sadness?

The term “depression” is often misused in everyday language to describe the inevitable periods of sadness, boredom, and melancholy that every person must experience at some time or another without it being an illness.

For example, it is normal to feel sad after the loss of a loved one or to feel a sense of failure when there are problems at work. However, if these moods recur every day for no particular reason, or even if they persist for a long time with a recognizable cause, it may be depression. Depression is in fact a chronic disease that meets very specific diagnostic criteria.

Apart from sadness, the depressed person has negative and self-condescending thoughts: “I really suck”, “I’ll never make it”, “I hate what I am”. They feel useless and have difficulty projecting themselves into the future. They have lost interest in activities that were once valued.

Prevalence

Depression is one of the most common psychiatric disorders. According to The National Institute of Mental Health (NIMH), 6.7% of the US population suffered from depression in 2016.

According to the World Health Organization (WHO), by 2020 depression will be the second most common cause of disability worldwide after cardiovascular disease.

Depression can occur at any age, including during childhood, but is most common in late adolescence or early adulthood.

Causes of depression

The exact cause of depression is not known, but it is probably a complex disorder in which many factors related to heredity, biology, life events, environment, and lifestyle play a role.

Genetics

Long-term studies of families and twins (separated or not at birth) have shown that depression has a genetic component, although no specific genes involved in the disease have been identified. Thus, a family history of depression may be a risk factor.

Biology

Although brain biology is complex, there is a deficit or imbalance of certain neurotransmitters, such as serotonin, in depressed people. These imbalances disturb the communication between nerve cells. Other problems, such as hormonal disorders (e.g. hypothyroidism, taking birth control pills) can also contribute to depression.

Environment and lifestyle

Poor living habits (smoking, alcoholism, low physical activity, excessive television or video games, etc.) and living conditions (precarious economic conditions, stress, and social isolation) are likely to have a profound impact on the psychological state. For example, the accumulation of stress at work can lead to exhaustion and ultimately to depression.

Life events

The loss of a loved one, divorce, illness, loss of employment, or other trauma can trigger depression in people predisposed to the disease. Similarly, abuse or trauma in childhood makes people more prone to depression in adulthood, particularly because it permanently disrupts the function of certain stress-related genes.

The different forms of depression

Major depressive disorder

It is characterized by one or more major depressive episodes (a depressed mood or loss of interest for at least two weeks in combination with at least four other symptoms of depression).

Dysthymic disorder

It is characterized by a depressed mood that has been present most of the time for at least two years and is associated with depressive symptoms that do not meet the criteria for major depression. It is a depressive tendency without a major depressive episode.

Unspecified depressive disorder

An unspecified depressive disorder is a depressive disorder that does not meet the criteria for major depressive disorder or dysthymic disorder. Examples are adjustment disorders with a depressive mood or adjustment disorders with anxiety and depressive mood.

In addition to this classification, other terms are used in the DSM4 (Manual for the Classification of Mental Disorders):

Depression due to anxiety

In addition to the usual symptoms of depression, there are also exaggerated fears and anxieties.

Bipolar disorder was previously known as manic depression.

This psychiatric disorder is characterized by phases of major depression with manic or hypomanic episodes (exaggerated euphoria, over-excitement, a reverse form of depression).

Seasonal depression.

A depressive state that occurs cyclically, usually during the few months of the year when the sun is at its lowest.

Postpartum Depression

In 60% to 80% of women, a state of sadness, nervousness, and anxiety occurs in the days following childbirth. This is called “baby blues” and lasts from one day to 15 days. Usually, this negative mood dissolves on its own. However, in 1 out of 8 women an actual depression sets in immediately or occurs within a year after delivery.

Depression after grief

In the weeks following the loss of a loved one, signs of depression are common and part of the grieving process. However, if these signs of depression last longer than two months or are very pronounced, you should see a specialist.

Complications

There are several possible complications associated with depression:

Recurrence of depression: This is often the case, as 50% of people who have experienced depression are affected. Treatment significantly reduces the risk of a relapse.

Persistence of residual symptoms: These are cases in which the depression is not completely cured and the signs of depression persist after the depressive episode.

Transition to chronic depression.

Risk of suicide: Depression is the leading cause of suicide: about 70% of people who die by suicide suffer from depression. Depressed men over the age of 70 are at the highest risk of suicide. Suicidal thoughts sometimes called “black thoughts,” are one of the signs of depression. Although most people with suicidal thoughts do not attempt suicide, this is a warning sign. Depressed people think about suicide to end the suffering they find unbearable.

Depression-related disorders: Depression has physical and psychological links to other health problems:

Anxiety
Alcoholism; abuse of substances such as cannabis, ecstasy, cocaine; dependence on certain drugs such as sleeping pills or tranquilizers
Increased risk of certain diseases: cardiovascular disease and diabetes. In fact, depression is associated with an increased risk of heart problems and stroke. In addition, suffering from depression may slightly accelerate the onset of diabetes in people who are already at risk. Researchers argue that people with depression also exercise less and eat less well. In addition, some medications may increase appetite and cause weight gain. All of these factors increase the risk of type 2 diabetes.

Symptoms of depression

According to the DSM4-R definition, the main characteristic of depression is a depressed mood, with a loss of interest or pleasure in almost any activity, for at least two weeks.

Sometimes irritability rather than sadness can be observed in a depressed child or adolescent. For a depression diagnosis to be made, the person must also have at least four other symptoms:

A change in appetite or weight, sleep and psychomotor activity
A reduction in energy
Feelings of worthlessness or guilt
Suicidal thoughts
Difficulty thinking, concentrating or making decisions

Other symptoms may be present:

Unusual aggressiveness or irritability
Excessive emotional sensitivity
Restlessness
The impression of thinking and acting “in slow motion”
A reduced libido
Headache, stomach pain or back pain
A sense of emptiness
Numbness to feelings

National Suicide Prevention Lifeline

These depression symptoms are accompanied by considerable suffering or deterioration in social, professional, and other important functional areas.

It should be noted that severe depression is often associated with other psychiatric problems such as anxiety disorders, eating disorders (anorexia, bulimia), or drug or alcohol abuse. In fact, many depressed people use these substances to relieve their symptoms, which can lead to other health problems (mental and physical).

Depression is also common among older adults. It often goes unnoticed because the symptoms (fatigue, loss of motivation, isolation) are age-related. A significant proportion of this population is reported to be undiagnosed and untreated. Some depression symptoms are more common in older people than in younger people:

Aggression and anger.
back pain, headaches, etc.
Isolation, withdrawal.
Confusion and memory problems.
Feeling of uselessness, frequent suicidal thoughts.
Detection of depression in children and adolescents

Depression is quite rare in kids at only about (0.5%). However, particular attention should be paid to any sudden change in behavior and to signs of withdrawal, absence or, conversely, irritability, and restlessness:

They no longer want to play, go out or visit their friends
Very irritable and often cries
complains of headache or stomach aches
Says that he no longer wants to live or that he should not have been born
Failure at school
He or she is growing up but is gaining very little weight.

In adolescents, depression can be difficult to distinguish from the crisis or confrontation that occurs in this phase of life. Depression affects 3-4% of adolescents, especially girls.

Pay attention to the following signs:

Abuse of alcohol, drugs, medication
Restlessness
Verbal abuse
Apparent indifference
A tendency towards isolation
A loss of interest in school
Signs of self-harm
A verbalization of suicidal thoughts.

People at risk for depression

No one is immune to depression. The following people would be at slightly higher risk.

People with a family or personal history of depression

People who are taking certain medications such as psychostimulants, steroids, corticosteroids, anabolic steroids, anticonvulsants, or birth control pills. The progestin in birth control pills can also affect mood. If this is the case, discuss it with your doctor.

From a sociological point of view, the following groups are most affected by depression.

Women: About twice as many women as men will suffer from depression at least once in their lives, although some marginal studies have sometimes found an equal frequency for both sexes. Women seek help more often than men when they have symptoms of depression, which may partly explain why they are more often diagnosed with the disease. At least two hypotheses have been put forward to explain this phenomenon:

- The female hormonal system, which is more likely to influence brain chemistry; for example, menopause may be associated with the onset of depression.
- More common problems such as poverty and violence in marriage.

Men living alone: May suffer from the loneliness which could lead to substance abuse and different types of addictions.

Youth: The first depression often occurs in late adolescence or early adulthood. Suicide is the second most common cause of death among young people after road accidents.

Older people: Between 15% and 20% of older people suffer from depression. They often go unnoticed. Among the possible causes:

- Loneliness
- Death of spouse or friends
- Physiological factors related to aging, such as a significant decrease in serotonin and other metabolic changes
- Malnutrition, which can cause nutritional deficiencies that contribute to depression (especially folic acid and vitamin B12).

Homosexuals: Various data, including a large cohort study in New Zealand, suggest that gays, lesbians, and bisexuals are at increased risk for mental health problems such as depression, anxiety disorders, and suicidal behavior.

People with chronic diseases: Chronic pain (e.g. migraine or back pain) or a disabling disease (diabetes, stroke, etc.) significantly increases the risk of depression, especially among young people.

Risk factors for depression:

Experience of repeated losses (death of spouse or parents, abortion, divorce or separation, loss of employment, etc.)
Suffers from chronic stress. An overloaded schedule, chronic lack of sleep, etc.
Feeling constantly overloaded and feeling that you are losing control over your life.
Use of alcohol or drugs, including tobacco.
Experiencing traumatic events in childhood (sexual abuse, maltreatment, neglect, testimonies of parental violence, etc.).
With nutritional deficiencies. A deficiency of vitamin B6 (especially in women taking oral contraceptives), vitamin B12 (especially in the elderly and people who consume a lot of alcohol), vitamin D, folic acid, iron, omega-3 fatty acids or certain amino acids can lead to depression.
Living in difficult conditions, receiving low wages or welfare benefits, being a single parent, being part of a Native American community in the US, and living in a sensitive urban area.
If you have already experienced one major depression, you are more likely to suffer another bout.
Living with a depressed spouse or parent.

Resilience: knowing how to recover

Resilience is the ability to overcome difficult and tragic experiences: the loss of a loved one, a fire, rape, accident, humiliation, etc. It requires a good dose of inner security and trust in life. The psychiatrist Boris Cyrulnik, who brought this concept back into the public sphere, called Psychological resilience.

This mental attitude is built by the bond of trust that is created with one or more important people. According to Boris Cyrulnik, resilience is “not a catalog of qualities that an individual possesses. It is a process that constantly connects us with our fellow human beings from birth to death “. Resilience seems to be more easily acquired in the first years of life. Later it is still possible to achieve it, but with more effort.

Prevention of depression

Sometimes, if you are showing signs of depression signs without severe depression or dysthymia, you can feel better simply by starting a healthier lifestyle for a period of time, e.g. going to bed early, getting more exercise and eating a balanced diet. But there are other ways in which you can prevent falling into depression, and especially prevent relapses after an initial bout of depression. In fact, several studies show that about half of the people who suffer from depression suffer from it more than once in their lives.

Activities, relationships, spirituality

Regular exercises, intensity, and frequency increase their effect. Persons who have exercised regularly before can be protected from depression between 2 and 9 years after they have stopped exercising.
Do not hesitate to speak openly about how you feel with your fellow human beings when you feel depressed.
If necessary, seek help from a trained psychologist, social worker, or psychotherapist.
Do not be too demanding of yourself.
Live in the moment. Avoid having negative thoughts, staying with the past, or anticipating the future.
Practice conscious meditation (cognitive mind-based therapy (MBCT) for depression, which was developed to reduce depressive episodes.
Get to know you better and carry out projects.
Recognize and overcome fears.
To nourish a form of spirituality.

If depression cannot be stopped by diet alone, it is likely to be aggravated by the wrong choice of food. But a relapse can also be prevented by good choices. Depending on the situation, a dietician or naturopath can help you choose the correct diet.

Make sure that you take in enough nutrients in your diet every day.
Eat more fatty fish (such as mackerel, herring, and salmon) because its meat is rich in omega-3 fatty acids, an essential nutrient.
Also make sure you eat foods that are rich in folic acids, such as offal, legumes, and dark green leafy vegetables. Some breakfast cereals and pasta are fortified with folic acid.
A study has shown that the Mediterranean diet can reduce the risk of depression. A diet that included a lot of processed foods in this study increased the risk of depression by 58%. In contrast, the Mediterranean diet reduced the risk of depression by 30%. How can a diet have such an effect on depression? Probably by providing omega-3, antioxidants, folates, and perhaps other elements.

Measures to prevent relapses

In order to prevent a relapse, it is advisable to continue all treatments (be it medication or natural health products as well as psychotherapy) 6 months to 24 months after full recovery.

If the treatment is interrupted as soon as the person feels better, the risk of relapse is over 50%. At this point, the disease may be more difficult to treat. There is also a higher risk of depression becoming chronic, so it is important to take care of yourself to avoid depressive episodes (treatment, psychiatric follow-up, psychotherapy, and lifestyle changes).

Medical treatments for depression

The treatment varies depending on the severity of the depression.

The mild to moderate form of depression can usually be effectively treated with psychotherapy. For severe depression, psychotherapy in combination with antidepressant medication is recommended as a treatment.

Several recent studies have shown that antidepressants are more effective for major depression. In practice, however, antidepressants are often prescribed for moderate depression.

Regardless of the severity of the depression, the combination of “conventional” medical treatment with therapy is effective.

If suicidal behavior is obvious, a hospital stay is necessary. Electroconvulsive therapy, which aims to provoke an epileptic seizure in order to stimulate the brain, is used in some cases of severe depression that does not respond to other treatments. It is administered under general anesthesia 2 to 3 times a week for 6 to 12 weeks. It is not known exactly how these treatments work.

In recent years, a new treatment has shown promising results where conventional treatments have failed: transcranial magnetic stimulation (TMS). It is prescribed to people with severe depression who have been resistant to two different types of antidepressants.

This treatment uses a powerful electromagnet that creates a short-lived magnetic field. As a result, the brain is exposed to short and repeated magnetic impulses during the sessions for a time defined in the protocol. Unlike electroshock therapy, it does not require general anesthesia.

Psychotherapy

Psychotherapy often helps to understand the meaning of depression, or at least what caused it. This therapy also helps you to find ways to feel better in everyday life. It teaches you how to respond better to life’s challenges and successes. Then it is possible to adopt behaviors that prevent you from relapsing.

There are various psychotherapeutic approaches. Cognitive-behavioral therapy is one of the most effective methods of treating depression in the short term. Mindfulness therapy is also a new and proven approach. However, the effectiveness of the treatment does not depend solely on the type of approach. The personal commitment and willingness of the depressed person and the trusting relationship that he or she builds with their therapist are important factors for success.

Antidepressant medication

Psychotropic drugs are substances of natural or artificial origin that are able to change the chemical balance of the brain. They act mainly at the synapses of the neurons, i.e. the spaces that enable the transfer of information between neurons.

The term antidepressant is reserved for a group of psychotropic drugs whose action is aimed at the disappearance of depressive symptoms. Antidepressants are divided into classes according to the type of effect they exert on the brain (blocking or stimulating a particular function). Each class of antidepressants has advantages and disadvantages.

There are different classes of antidepressants. Here are the most commonly prescribed ones.

Tricyclic antidepressants, including clomipramine (Anafranil®), amitriptyline (Elavil®, Redomex®, Laroxyl®) and imipramine (Tofranil®), dosulepin (Prothiaden®), doxepin (Sinequan®, Quitaxon®), maprotiline (Ludiomil®), nortriptyline (Nortrilen®). Used since the early 1960s, they cause many undesirable effects (drowsiness, weight gain, constipation, dry mouth, reduced libido, etc.). Today they are used less.

Selective serotonin reuptake inhibitors (SSRIs), including citalopram (Celexa®, Seropram®), fluoxetine (Prozac®), fluvoxamine (Luvox®, Floxyfral®), paroxetine (Paxil®, Deroxat®, Divarius®) and sertraline (Zoloft®) This is usually the first choice for treating major depression. They are equivalent to tricyclic antidepressants in terms of efficacy but are better tolerated. However, they may be associated with certain side effects: agitation, weight gain, nausea, nervousness, insomnia, headaches, and reduced libido.

Serotonin and norepinephrine or norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor®), duloxetine (Cymbalta®) and milnacipran hydrochloride (Ixel®) They are among the most effective antidepressants because they act on two types of neurotransmitters simultaneously. However, they can cause more side effects. They are usually used when other drugs are not enough to relieve the symptoms.

MAOIs (monoamine oxidase inhibitors): Iproniazid phosphate (Marsilid®), moclobemide (Moclamin®), phenelzine (Nardelzin®, Nardil®)

Warning! SSRI and SNRI antidepressants put children and adolescents at increased risk of suicidal thoughts or behavior (compared to placebo). These antidepressants are not indicated for use in children and adolescents because studies have not demonstrated their effectiveness in children and adolescents. Other reports indicate that they can cause agitation, hostile behavior, and self-injury in anyone taking them, including adults. Therefore, the use of these drugs should be carefully monitored by a doctor.

According to a 2010 study, taking antidepressants during the first trimester of pregnancy increases the risk of miscarriage by 68%. Talk to your doctor if you are pregnant and taking medication.

It is not easy to find a medicine that has the best therapeutic effect. It may take several weeks or months to experiment with different products.

Also, a significant proportion of people with depression respond little or not at all to antidepressants. The psychiatrist can then prescribe two different classes of medication simultaneously.

A note on withdrawal from antidepressants

Antidepressants should never be discontinued suddenly, as they can cause symptoms when discontinued. The dose should be gradually reduced over several weeks according to your doctor’s advice. However, antidepressants do not usually cause dangerous withdrawal symptoms, but only temporary symptoms.

It is desirable, but not always essential, to wait a few days (or longer, depending on the medication) before starting another medication or natural treatment. Consult your doctor.

Support or support groups

Group psychotherapy sessions are organized in hospitals, clinics, and even in private practices as part of a short therapy (12-15 weeks). For depressive people, this is a way to break through isolation or to maintain a valuable social bond. There are also groups for family members and friends of people with depression.

Complementary approaches to depression

Depression requires diagnosis and follow-up care by a healthcare professional. Self-medication is not recommended. St. John’s wort, SAMe and 5-HTP can interact with antidepressants, for example, and increase their effectiveness. Their use should be monitored by a health professional.

St. John’s wort (Hypericum perforatum): The antidepressant effect of St. John’s wort has been proven in several clinical studies and meta-analyses (including a very comprehensive study in 2005). Three meta-analyses have confirmed that St. John’s wort is more effective than a placebo and as effective as synthetic antidepressants for mild to moderate depression while causing fewer adverse effects than synthetic antidepressants. The antidepressants with which St. John’s wort has been compared in clinical trials include fluoxetine (Prozac® ), sertraline (Zoloft® ), and paroxetine (Paxil® ), as well as older class drugs such as imipramine. A meta-analysis conducted in 2009 also concluded that St. John’s wort and SSRIs are equally effective.

In the case of severe depression, studies have produced contradictory results. The authors of a meta-analysis published in April 2005 examined 12 studies and concluded that the effect of St. John’s wort in these cases was minimal. However, a later study comparing St. John’s wort extract with paroxetine (Paxil®) showed positive results for moderate to severe depression. Overall, it is not yet clear whether St. John’s wort is comparable with antidepressants for severe depression.

Precautions

The use of St. John’s wort should be monitored. In fact, this plant interacts with many medicines and can cause side effects.

St. John’s wort is contraindicated in combination with antidepressants, especially serotonin reuptake inhibitors.

St. John’s wort interacts with digoxin, theophylline, antivitamin K, cyclosporine, but also with oral contraceptives. These interactions reduce the effect of these drugs. It also interacts with some antiretroviral drugs used against HIV.

So the official recommendations are clear:

St. John’s wort is not recommended for women taking oral contraceptives. People taking antidepressants or antiretroviral therapy should not use St. John’s wort. In addition, it is strongly recommended not to combine any medication with St. John’s wort without medical advice, as this may reduce the effectiveness of some of these drugs. Remember that this applies to all medicines. You should always avoid combining them without medical advice.

Physical activity: All health professionals agree that physical activity is essential for health and therefore for mental balance. Many of the metabolic changes induced by exercise improve brain function. For example, physical activity releases endorphins, which are associated with a feeling of well-being.

Several clinical studies have investigated the positive effects of exercise in depressed people. A meta-analysis conducted in 2009 showed that the effects of exercise on depression are comparable to those of cognitive therapy, although the methodology of clinical studies is often criticized.

Most experts recommend physical activity for about 30 minutes, at least 5 days per week. The minimum amount to feel the benefits would be 3 periods of 20 minutes per week.

Fish oils (Omega-3): Epidemiological data have shown an inverse relationship between fish consumption and depression. With regard to clinical studies, there is also encouraging evidence for depression, postpartum depression, and bipolar disorder. Based on these data, several researchers recommend fish oil as an adjuvant treatment for depression. In addition, a 2010 clinical study involving 432 depressed patients in Quebec and Ontario concluded that fish oil relieves the symptoms of depression in a similar way to antidepressants, but only in people who do not have an anxiety disorder in addition to depression.

Dosage

The optimal dose was not determined, but in clinical studies, the dose of EPA/DHA was between 1 g and 4 g per day.

Light therapy: Light therapy has been shown to be effective in the treatment of seasonal depression. For non-seasonal depression, many studies have shown that light therapy was only modestly effective as a supplement to conventional treatment. However, the authors note that the identified clinical trials were generally of short duration and with few subjects. Since then two further clinical studies have been published. Both highlight the effectiveness of bright light therapy in reducing the symptoms of non-seasonal depression and improving overall well-being. In one of these studies, which lasted 5 weeks, bright light therapy consisted of exposing the patient to 10,000 lux of light for 30 minutes each day. Furthermore, in a clinical study published in 2005, no antidepressant effect superior to placebo was observed in a group of 81 elderly people.

SAMe (S-adenosyl-L-methionine) is a molecule that plays an important role in the metabolism of hormones and neurotransmitters and is involved in many biochemical reactions. Several studies have concluded that SAMe is more effective than a placebo in the treatment of depression and as effective as tricyclic antidepressants. It should be noted that most of the studies reviewed by the researchers were conducted with SAMe in injection form. The results of a recent open-label study (without a placebo group) suggest that patients who did not respond well to venlafaxine, an antidepressant belonging to the selective serotonin reuptake inhibitors (SSRIs), responded well to the addition of eSAM. Although a recent study suggests that oral SAMe may be effective as a supplement to antidepressant treatments, there is not enough data to recommend it.

Dosage

Take 400 mg, three times a day.

Notes

To avoid possible gastrointestinal disturbances and nausea in sensitive individuals, start with a dose of 200 mg twice daily, and gradually increase the dose.
Although the positive effects are felt after a few days, it may take up to 5 weeks before you see full results.

B vitamins: Studies have found a deficiency of B vitamins, especially B6, B9 (folic acid) and B12, in depressed people. A deficiency of these vitamins can contribute to depression. These nutrients play an important role in the synthesis of neurotransmitters, including serotonin and dopamine. In 2008, a study of 27 depressed people showed that taking 10 mg of folic acid daily in addition to 20 mg of fluoxetine (Prozac®) reduced depressive symptoms more than fluoxetine alone.

Currently, physicians only recommend the use of group B vitamin supplements if a deficiency is suspected or detected. However, many doctors suggest that patients suffering from depression should follow a diet rich in folate (a natural source of vitamin B9).

5-HTP (5-Hydroxytryptophan): About 20 studies have examined the effectiveness of 5-HTP in relieving the symptoms of depression (990 subjects in total). Most of them were small and 11 did not contain a placebo group. Of the 10 double-blind, placebo-controlled trials, 7 concluded that 5-HTP was superior to placebo. The data set is therefore difficult to interpret.

Dosage

Take 50 mg to 100 mg, three times a day.

Other approaches

Massage therapy. Positive results have been reported in studies on depression in pregnancy and after birth, as well as in children and adolescents, and in patients with cancer, HIV/AIDS, and kidney disease. Several of these studies report an improvement in mood, sleep, immune function, and a decrease in anxiety, stress, and fatigue, but generally without an assessment of the benefits over long periods of time. A meta-analysis conducted in 2010 (involving 786 patients) also concluded that massage has a positive effect on depressed people, although no specific massage protocol has been validated. At the same time, a review of the scientific literature reports further positive effects: Stress reduction (decrease of cortisol) and activation of the central nervous system (an increase of serotonin and dopamine). Therefore, massage can be regarded as a supplement to conventional treatments.

Yoga: An open-label study in 2005 with 113 subjects hospitalized for psychiatric problems suggested that yoga practice improves mood. In addition, a summary of 8 randomized studies evaluating the effectiveness of yoga in treating depression was published in 2010. All studies reported positive effects of yoga on depressive symptoms, but the quality of the studies is not sufficient to reach a final conclusion. However, the authors believe that yoga is an effective method to complement the traditional treatment of depression.

Dance and music therapy: A randomized study of 40 adolescents with mild depression examined the effects of a 12-week dance therapy program. At the end of the experiment, the adolescents in the dance therapy group had fewer symptoms of psychological stress than those in the control group. In addition, an analysis of 5 randomized trials in 2008 showed that music therapy improves the mood of depressed people. However, larger clinical trials are needed to accurately assess the effectiveness of these methods.

Massage for babies: This approach could contribute to the well-being of the mother affected by depression and her child. In one clinical study, 40 babies aged 1-3 months, whose mothers were depressed, were randomly assigned to 15-minute massages or rocking treatments twice a week for 6 weeks. The children in the massage group gained more weight and showed a calmer temperament and better emotional and social disposition. They seemed less stressed, cried less, and fell asleep more easily.

In another randomized clinical trial published in 2001, 62 mothers with postpartum depression had better interactions with their children as a result of the massage. Their state of mind also improved. However, a quarter of the participants withdrew from the study over time, suggesting that this approach may be difficult to adopt.

Ginkgo biloba: The efficacy of this Chinese plant is recognized among other things to relieve the symptoms of depression suffered by some elderly people with degenerative dementia (such as Alzheimer’s disease). Ginkgo biloba may also be of interest to elderly people who do not respond well to antidepressants.

It is possible that ginkgo can also help regulate sleep in depressed people of all ages with this problem. It could, therefore, be considered as a complementary treatment, as a small clinical study suggests. The ginkgo extract used, EGb Li 1370, was administered for 4 weeks (240 mg per day) in addition to medication.

Dosage

From 120 mg to 240 mg of standardized extract per day (50:1), to be taken in 2 or 3 doses.

Saffron(Crocus sativus): In Persian medicine, saffron is used against depression. Five preliminary studies showed that taking 30 mg saffron a day was more effective for depression than taking a placebo. In 2007, a randomized double-blind clinical trial of 40 subjects even concluded that saffron is as effective as fluoxetine (Prozac®) for mild to moderate clinical depression. However, these studies were small and further research will be needed to confirm the effectiveness of saffron.

Traditional Chinese Medicine: Although little research has been done on this topic, it appears that acupuncture, Chinese pharmacopeia, and Qi Gong can relieve the symptoms of depression. A placebo-controlled study at the University of Arizona in 1998, involving 34 women suffering from depression, found a 43% reduction in depression symptoms (22% with placebo). The success rate was comparable to treatment with antidepressants or psychotherapy. The relapse rate, 6 months later, also corresponds to the results of recognized treatments. The U.S. National Institutes of Health also reported that research showed that acupuncture “can alter the chemical balance of the brain by modulating the production of neurotransmitters and neurohormones. However, in 2010, the authors of a meta-analysis of 30 studies and over 2,800 depressed patients considered that the data were not sufficient to conclusively conclude that acupuncture is effective for depression. However, two of the studies showed that acupuncture was beneficial in combination with conventional antidepressant treatment.