Five-a-day to keep the blues away – midweek ramblings on depression

October 29, 2008 at 4:26 pm (Alternative Medicine, Bad Science, Big Pharma, Nutritionism, Remedies, Supplements) (, , , , )

Via the Holford Watch miniblog: Guardian story on The Foresight Project on Mental Capital and Wellbeing. I’ve even stolen HW’s idea for a campaign name. Apparently, a “five-a-day”-style campaign to boost the mental health of the nation is needed to combat rising rates of depression, anxiety and drug abuse. The five actions recommended are these: developing friendships, being physically active, fostering curiosity about the world, continuing education throughout life and doing voluntary work. Funnily enough, not one of the recommendations is to take 5-HTP supplement tablets. Nor do they recommend any of these: Depression and natural therapies. Homeopathic potassium phosphate, Bach flower remedies and Inositol (AKA Vitamin B8, according to Wikipedia) are listed on this page along with saffron and Reiki (Reiki? It’s “energy medicine” or “bullshit” as I prefer to refer to it). The reference provided for saffron in depression is for a paper that was apparently presented at the International Symposium on Saffron Biology and Biotechnology and this paper includes these lines:

On the basis of these results, the antidepressant effect of C. sativus stigma extracts may be mediated via safranal and crocin. Crocin may act via the uptake inhibition of dopamine and norepinephrine, and safranal via serotonin.

Whatever natural therapy I am reading about for depression, it always seems to act on a specific neurotransmitter. It would be nice if it were that simple, but as the recommendations of five-a-day actions would seem to suggest depression seems to be a bit more complicated than that. Taking physical activity makes sense to me, not least because daily physical activity is associated with a lower risk of psychological distress and there are benefits of exercise for the treatment of depression. While trawling Google Scholar and Pubmed for studies that fit with my preconceptions (I believe it’s known as cherry-picking), I found a PDF of a study with what I thought were some really interesting points. Here, we are told that in a study looking at three groups (exercise; medication; combination) “During treatment, several in the combined group mentioned spontaneously that the medication seemed to interfere with the beneficial effects of the exercise program”. This ties in with the view that taking pills for an ill can be disempowering and also makes me wonder if reductionist AltMed gurus with their magic treatments or Big Pharma salesmen with their multiple small studies purporting to show benefit for their particular anti-depressant solution are selling us short. I’m not very good at discussing this sort of thing but, fortunately, some people from the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center are rather better at it than I am.

One of the positive psychological benefits of systematic exercise is the development of a sense of personal mastery and positive self-regard, which we believe is likely to play some role in the depression-reducing effects of exercise. It is conceivable that the concurrent use of medication may undermine this benefit by prioritizing an alternative, less self-confirming attribution for one’s improved condition.

As Oliver Burkeman once said, some people are just really strange. I find it weird that giving someone an antidepressant can hinder their recovery from depression simply because they no longer feel like their recovery is “all their own work”. But then… I consider lots of things people think, say or do to be weird – perhaps it is actually me that is strange.

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9 Comments

  1. anandamide said,

    This rings true to my own experience; I’m prone to bouts of depression and sensed something amiss about a year ago. I went to my GP to ask for a referral to a therapist (which never came through…) and some ADs ‘just in case’ (with a history like mine, getting hold of an SSRI is no problem). After 5 months I decided to drop the meds, as they were making me feel very weak and tired, which stopped me going to the gym. I figured that, ultimately, the thing most likely to prevent and lift any nascent depression would be doing stuff I enjoy, especially if that included exercise.

  2. apgaylard said,

    Nice post. I quite liked this advice. It’s not five things, though it is a multiple thereof.

  3. Neuroskeptic said,

    Interesting post. I blogged about a weird video tied in to this campaign here. But the basic idea seems sensible. promoting mental health is something we can all agree upon, and I’m of the view that getting people exercising is almost always a good thing, from the point of view of physical health, happiness, the environment – it’s a no brainer.

    I have to say that my personal experience is pretty much the exact opposite of anandamide’s – antidepressants make me much more active. I suffered from low mood for a long period and it made sticking to a program of exercise basically impossible. I would start and then lose motivation within a week. Within days of starting on an SSRI, my physical energy levels were much higher, and now I get restless and fidgety if I don’t go to the gym every day – my fitness has never been better and I’m running around all over the place.

    Now finally – jdc points out the absence of nutritionism in the Foresight campaign, but sadly apgaylard’s link leads quickly to something a little more dubious…

    http://www.mentalhealth.org.uk/campaigns/food-and-mental-health/

    I haven’t read the full reports, and I’m not an expert so I don’t know if this is woo or not. they seem very keen on fish oils and the idea that our soils are depleted of minerals, though.

  4. jdc325 said,

    APGaylard – that is brilliant. Any future attempts to advise the public should definitely include pictures like those accompanying MHF’s ten ways to keep the blues at bay.

    Neuroskeptic – hadn’t yet seen that post of yours. Will watch the vid when I’m on my PC at home.

    Re: SSRIs – it seems that asthenia and low libido are two very unfortunate side-effects of these pills. I would guess that exercise and sex are two things that may boost someone who is depressed. In fact, if you combine them you can have sexercise. Ironic, though, that a treatment that seems to help depression* can actually have side-effects that wouldn’t be conducive to relief from depression.

    FWIW, my personal experience is that ADs tend to leave me knackered by mid-afternoon if I’m doing anything physical. I previously had a job where I had to work very hard physically and the pills seemed (anecdotally) to make it harder to keep going in the PM. SSRIs I would say helped a bit with my depression, and maybe some of the natural remedies I tried perhaps helped me a little bit too. Having got over the worst, though, nothing I took helped me to improve my mood. Thinking more rationally probably helped more (long-term) than any pill I ever took. Perhaps the long-term remedy for depression should be a critical thinking course or something. “Welcome to today’s lecture: How not to think illogical thoughts about worthlessness and death”. Or am I thinking of CBT?

    * PJ has an interesting post here: “efficacy increases (relative to placebo) as the severity of depression increases reaching NICE’s criteria for severe depression” [The drugs don't work] which is one of many: See here for more.

  5. apgaylard said,

    The shark of nutritionalism is lurking just beneath the surface of sensible advice on mentalhealth.co.uk. A report on the page that Neuroskeptic linked to (Feeding Minds: the impact of food on mental health) references Holford eleven times. That’s enough to set my woodar off. Big time.

    For instance: avoiding sugar, deep-fried food, junk foods, refined and processed foods, cigarettes, and alcohol; whilst consuming organic/free-range eggs, organic or wild fish – especially, salmon, mackerel, sardines and fresh tuna will help you avoid acetylcholine deficiency, which can cause: deterioration of memory and imagination, fewer dreams, increased confusion, forgetfulness and disorganisation.

    I’ll defer to Holfordwatch on this one; but it sounds like the sort of broad and overly-optimistic claims of cranky nutritionalism.

    It’s a shame, because their top-level message is fine.

  6. jdc325 said,

    Nutriwoo gets everywhere. My last post was about an NLP website that featured some Holfordism and I’ve written before about the renowned homeopath Dr O and his assumption of nutritional expertise. It sometimes feels like “We all eat food. Therefore, we are all nutritionists.”

    Why the fish and eggs need to be organic or free-range is beyond me. I’ve never seen any evidence that organic/free-range food contains more acetylcholine precursors than non-organic/non-free-range food.

    I’ve not really looked for evidence that acetylcholine deficiency due to poor nutrition is a problem for anyone, but I know that problems with cholinergic system has been hypothesised to be cause of certain disorders*. I think the site is equivocal on supplements (“at the moment the evidence is not strong regarding the benefits of nutritional supplements…”), but they have probably gone further than the evidence allows in terms of food claims.

    *There is some interesting stuff on Pubmed re acetylcholine and delirium, AD etc…

    “Acetylcholine synthesis involves various precursors, enzymes, and receptors, and dysfunction in these components can lead to delirium. Insults to the brain, like ischemia and immunological stressors, can precipitously alter acetylcholine levels. Imbalances between cholinergic and other neurotransmitter pathways may result in delirium.” Linky

    “Impairment of cholinergic neurotransmission is a well-established fact in Alzheimer’s disease (AD) but there is controversy about its relevance at the early stages of the disease.” Linky

  7. Neuroskeptic said,

    apgaylard : it is a shame, and its doubly a shame that this is a government sponsered website. (at least indirectly, the video I linked to, points to a website, which links to the Mental Health Foundation all over the place, and the video was government commissioned with the help of the MHF).

    Maybe HolfordWatch or someone will “do” the report. I would, but I really don’t have the time nowadays… gripe gripe

    jdc : I’m well aware of the excellent work PJ did on that particular topic! Don’t forget Robert Waldmann’s posts too. As for antidepressants, people clearly respond differently. Certainly I can descibe my experience as 100% positive, and I’ve found that my afternoon energy levels were much increased, not decreased. :)

  8. anandamide said,

    ‘Increased energy levels’ describes only the 2 weeks I experienced 3 weeks into the course, when I was unexpectedly lifted into the stratospheric heights of hypomania.

    Ahh, happy days…

  9. Claire said,

    Came across this , report of a conference on nutrition and mental health, featuring Andrew McCulloch, Mental Health Foundation CEO and a couple of other MRC funded scientists but also nutritional therapists including “renowned psychologist and nutritionist Patrick Holford”.

    The article’s (broad and overly optimistic?) conclusion:

    “…Mental health can be affected by a range of issues and events that we all encounter – and often have little control over – throughout our lives. Yet when the conference drew to a close, an invaluable message shone through: “The treatment of mental illness, with nutrition, is something we can all control.”5 Empowering to say the least! “

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