For some, everything about the day is difficult. From getting up in the morning to interacting with friends, family, and colleagues to doing everyday work and activities can be painful. Energy levels may be low, motivation even lower, and a general sense of pain may seem to accompany everything in life. This type of depression is ruled by decreased levels of the neurotransmitter serotonin.
For others, depression may not feel this way at all. On a day-to-day basis you may be excited to visit with friends and family, eat at that wonderful new restaurant, or go on vacation. And yet, none of it brings you any pleasure. In fact, you may try to eat lots of foods you crave, drink more alcohol, or even indulge in riskier behaviors including drugs. Why, you might ask? Well, this is a different type of depression that is ruled by our reward system neurotransmitter dopamine. Unfortunately, it never seems to bring you the pleasure you so desperately crave. Often, regardless of which type of depression you may feel (if not a combination of both), you ask yourself over and over again, “Why do I feel this way?”
Treatment for depression certainly varies. Some choose to hire a therapist to try and work through their difficulties. Medications including serotonin reuptake inhibitors (SSRIs) such as Prozac, Lexapro, and Zoloft are often common treatments. Unfortunately, many do not have full recovery from depression, have no improvements at all, or suffer endless medication side effects including weight gain, loss of libido, nausea, dizziness, dry mouth, and diarrhea. Others choose a more natural approach to SSRIs such as St. John’s Wort or targeted amino acid therapies where the protein precursors to neurotransmitters are taken to try and bolster production. For others, the depression is ignored altogether to avoid the embarrassment of admitting that something is even wrong. Unfortunately, even in this modern era, mental illness is often not spoken of and can carry a stigma.
The first thing that I explain to anyone who comes into my office with depression, anxiety, obsessive compulsive disorder, or other mental illness is that it is a biochemical problem and not a personality problem. These issues require early treatment because the longer the problem lasts, the harder it is to fix due to brain plasticity. These days we hear of brain plasticity in regards to preventing age-associated dementia primarily. However, it is also involved in everything we do. In fact, our brain gets quite good at doing whatever we ask of it. This could be studying for school, building budgets, writing, computer programming, or playing an instrument. The more we do something the better we become. This, unfortunately, also holds true for depression. If you are depressed for a week or even a few months it is something that may be relatively easy to recover from. The longer the time you are depressed for, the harder it is to find happiness again. I have known individuals who have been depressed for a lifetime who cannot even remember what happiness feels like. They may even feel a sense of guilt when they finally feel happy for the first time.
In the end, the best way to understand and approach depression and other neurotransmitter disorders is by understanding the biochemistry and genetics that can cause these issues. While certainly the science may scare many, understanding the basics is well within your reach.
Biochemical Pathways
In biochemistry, various neurotransmitters are synthesized (produced) in a pathway. The interesting part of this is that no one pathway works in isolation. It is much more akin to looking at cogs in a machine. One cog spins in one direction and influences another cog’s rotation. Within each pathway we have substrates which serve as the ingredients in a neurotransmitter’s recipe. Along the way these substrates require enzymes to speed up the process.
These enzymes require cofactors (often vitamins and minerals) to work effectively. A combination of sufficient substrates, enzymes, and cofactors will result in the product—the neurotransmitter. These pathways are quite interconnected. Often one pathway produces a product that becomes a substrate in a subsequent pathway. As a particular pathway struggles to function from a less than efficient enzyme, a substrate that is inadequate or a missing cofactor, it will affect the other pathways that it crosses.
From a practitioner’s perspective this biochemistry should be incredibly important because it may be influenced by everything from diet and medications to genetics. For example, perhaps you decide to try a juice fast only to find that you suddenly are depressed. In this case, you may be experiencing a sudden drop in protein levels. Proteins break down into amino acids in the body and amino acids such as tryptophan are required for serotonin synthesis. Additionally, all enzymes are made up of various proteins and production can slow when dietary protein intake is low. In a different scenario, maybe you stop taking a multivitamin. Falling off the wagon of taking supplements can happen to anyone. Again, over time you may also begin to experience depression. This is because you now have insufficient vitamins or minerals to act as cofactors in a pathway.
A Genetic Primer
For many, the problem is one of genetics. For every enzyme used in a pathway there are genes that provide the information to produce it. Whenever we discuss genetics it is important to know that we each receive half of our genetics from our mother and half from our father (called an allele). Each allele is either the wild type (meaning it is the usual variation and functions fully) or it contains a genetic polymorphism called a mutation). This means your genetics may either contain two wild type alleles, a wild type and a mutation (heterozygous) or two mutations (homozygous). Some polymorphism can be protective and others can cause issues for us.
There are two very important things to realize about genetics. First, just because you have a genetic mutation does not mean that it is active. It requires an environmental influencer to activate it. This is called epigenetics. This influence might be a bacterial or viral infection, excessive stress, or poor lifestyle choices. This explains why you might be fine for many years only to have depression develop suddenly. The second important thing to think about with genetics is that an enzyme is rarely completely missing. Usually the enzyme will still function, but at a fraction of full strength. I like to demonstrate this via a traffic analogy. With two wild type alleles, the traffic in a three lane highway flows normally. Cars move easily along the road and there are no traffic backups. With a heterozygous mutation, one lane may be shut down. The traffic still moves, but there are delays.
Finally in a homozygous mutation, two out of three lanes are shut down. This results in quite a traffic jam. Sure there are some cars getting through, but they are moving at a snail’s pace. Genetic polymorphisms may be overcome by providing more substrate (often as in specific amino acids in targeted amino acid therapies) and cofactors (vitamins and minerals). Unfortunately, it is not usually as simple as looking at one isolated gene in one isolated pathway.
Don’t miss next month’s issue to learn more about these pathways, and how a nutrigenomics practitioner can then use the genomic analysis to determine the status of the genes that can influence your health.
Jessica Pizano is the owner of Fit to You, LLC, which offers personalized training programs and nutrition/health counseling. Her concentrations include genetics and nutrigenomics, general health and fitness, weight loss, food allergies/sensitivities, autoimmune disease, post-rehabilitative work, training/nutrition for medical conditions, obesity intervention, pre- and post-natal exercise and nutrition, and Pilates. A certified personal trainer and a corrective exercise specialist through the National Academy of Sports Medicine, she is also certified in mat Pilates through PHI Pilates and earned her Clinical Exercise Specialist and Longevity Wellness Specialist through the American Council on Exercise. She is completing a master’s degree in human nutrition that emphasizes functional medicine at the University of Bridgeport. She may be contacted at (860) 321-7234 or online at www.fittoyouct.com.