Rachel can't sleep, can't eat. She is in the midst of a family health crisis, marriage problems, and other issues. She's faced bouts of mild depression all her life, but this is suddenly much worse -- a severe case of anxious depression.
Rachel needs an antidepressant, most psychiatrists would say. And they're right, says Henry Emmons, MD, a general and holistic psychiatrist in Minneapolis-St. Paul, Minn. "An antidepressant can quickly and potently address her depression. But all too often, the treatment stops there."
If she'd had a heart attack, her cardiologist wouldn't just prescribe pills for cholesterol and blood pressure and leave it at that, Emmons notes. She'd get advice -- on stopping smoking, eating better, getting more exercise, learning how to cope with stress.
"Even well-meaning psychiatrists tend to see depressed patients as brain chemistry gone awry rather than as a complex integration of mind, body, and spirit," Emmons writes in his newly published book, The Chemistry of Joy. "Even responsible, caring physicians -- psychiatrists as well as general practitioners -- are unaware that depression requires a 'brain-healthy' diet and lifestyle."
The chemistry of joy, Emmons says, is built on a foundation of specific nutrients -- like B-vitamins, omega-3 fatty acids, and antioxidants that affect brain chemicals involved in depression. It is the cornerstone of the three-part program he describes in his book.
Blending Western and Eastern Medicine
Emmons believes in mind-body medicine, so he also draws on wisdom from two ancient Eastern systems -- Ayurvedic medicine and Buddhist philosophy.
Through Ayurvedic medicine, we discover our specific mind-body type, which offers clues to finding balance in our lives, he explains. Through study of Buddhist philosophy, we learn how to rein in thoughts, quell our fears, open our hearts, and practice forgiveness, which provides the path to joy.
Depression is more than a brain chemical crisis -- it is very much a spiritual crisis, says James S. Gordon, MD, a psychiatrist and founder of the Center for Mind-Body Medicine in Washington, D.C.
"Depression and anxiety develop from how one feels and looks at the world, at one's own life," he tells WebMD. "Treating depression isn't just about getting it under control with antidepressants. It's often a matter of transforming your whole life. As we deal with any difficulty in our lives, we can look at depression as an opportunity for profound change."
Buddhism and Ayurvedic medicine "have been used for centuries, and people may find them useful," says Gordon. "There's really no research data on those approaches, but it's obviously something that [Emmons] has found useful in his clinical practice. My sense is that these traditional approaches can help people."
Charles L. Raison, MD, a professor of psychiatry at Emory University School of Medicine in Atlanta, is "agnostic about traditional systems like Ayurvedic medicine," he tells WebMD. "But they point the way to something we've really gotten wrong in the West -- that just because our bodies work like machines, we shouldn't be treated as machines."
Step 1: Your Brain's Health
From Western medicine, we have gained great insights into brain chemistry -- the balance of chemicals in the brain that determine, to a great extent, our mood, energy level, even our outlook on life, Emmons writes. An imbalance of these brain chemicals -- serotonin, dopamine, and norepinephrine -- results in depression.
A "brain-healthy" program involves specific nutrients that will help boost specific brain chemicals, depending on the type of depression you have - anxious depression, agitated depression, or sluggish depression, he explains.
"Many patients who try to eat well, exercise frequently, and live a healthy life remain ignorant of the specific diet and lifestyle choices that might cure their insomnia, lift their mood, soothe their anxiety, and generally ease their depression," he writes.
Emmons' term for Rachel's condition is "anxious depression," which he says indicates that her serotonin levels are low. He identifies two other types of depression: "agitated depression" (high levels of norepinephrine and dopamine, with low serotonin levels) and "sluggish depression" (norepinephrine and dopamine levels are low).
To increase her serotonin levels, Rachel needs a diet high in complex carbohydrates -- root vegetables (like sweet potatoes), whole grains, beans, legumes -- plus a little protein with every meal, he says. She should eat several small meals during the day or three meals plus a couple of snacks. She should also eat foods high in omega-3 fatty acids, like salmon.
Emmons advised her to take these supplements: B-6, B-12, folate, omega-3, vitamins C and E, beta-carotene, and selenium. A multimineral supplement with calcium, magnesium, chromium, copper, zinc, and manganese is also important (although most good multivitamins contain these minerals), he says.
The Case for Supplements
Over the last decade, a growing number of studies have shown that these supplements can help with depression, says Gordon. "I've looked at the evidence, and there's enough evidence that these may be helpful. We don't know for sure -- but I prescribe them because there's no downside, if they're taken in reasonable doses. And there's enough evidence to suggest that they might be helpful," he tells WebMD.
Published studies have shown a relationship between B vitamins and depression, Gordon says. "Whether it causes depression, we don't know. But studies show that increasing levels of B vitamins -- particularly when taking antidepressants -- improves mood. The evidence is not ironclad, but enough is there that I feel very comfortable prescribing it."
Omega-3s are known to reduce inflammation, protect against heart disease and cancer, and help with arthritis, he says. "It stands to reason that if there is any inflammatory process going on in depression -- and there may be -- omega-3s might help. Studies suggest that omega-3s help with bipolar disorder, but the evidence is not as strong about whether it helps depression alone."
Rachel's symptoms improved very quickly -- with a low-dose antidepressant, nutritional supplements, and counseling to help her deal with pressing family issues, Emmons reports. She was willing to try Ayurvedic medicine and Buddhism to gain better balance in her life -- to gain control over her thoughts and quiet her mind, he says.
"With antidepressants, there's always a point at which the drug just doesn't seem to work well anymore and when side effects begin appearing," he says. "For the vast majority of people, they are not an adequate long-term solution. Over time, if you're living as stressfully as before, if your diet hasn't changed, you're still overresponding to stress, you're going to get depressed again."
Step 2: Your Mind-Body Type
In Ayurvedic medicine (used for centuries in India), there are three mind-body types -- Air, Fire, and Earth, explains Emmons. Each is based on your body type -- whether you're a thin, wiry type, or strong and muscular, or a bit on the hefty side. Other patterns -- whether you tolerate hot weather, have straight or curly hair, get constipated easily or not, sleep easily or not -- are all factored into your Ayurvedic type.
Air types like Rachel are most prone to anxious depression, he says. Fire types align with agitated depression, and Earth types are likely to have sluggish depression.
"Someone like Rachel, who is thin by nature, has an active, restless mind," Emmons explains. "She needs to do things that will calm her nervous system -- aerobic exercise that is light but repetitive like walking, easy jogging, bicycling. Being out in nature is especially helpful for Air types, because it is grounding. Moving the body in a repetitive fashion, as opposed to competitive activity, elevates serotonin levels. It's a potent treatment."
Also, Rachel needs to develop structure in her daily life -- a more predictable eating pattern and regular exercise. A regular sleep schedule helps keep the body's hormones regulated, an important factor in fighting depression. "With depression, the body has failed to correct itself when under stress, so all mechanisms are disrupted," Emmons explains.
Rachel should also add warmth wherever possible -- with soothing foods and drinks, hot baths, and massages. She also can benefit from "conscious breathing" -- a slow and regulated breathing practice. "It involves bringing attention to the breath," he explains. "Count to four as you breathe in slowly, count to two while you pause, then count to seven while you breathe out even more slowly. Even five minutes of this can be calming."
Fire types generally need cooling, calming foods and activities, he adds. Earth types need stimulating foods and activities to keep them motivated.
Step 3: Your Spiritual Needs
By studying Buddhist philosophies, one can overcome the spiritual crisis of depression, says Emmons.
"Depression is a sign, a signal, and it's important to take heed of what it's trying to tell us," he tells WebMD. "It often means we need to change our diet, get more exercise. But it might be pointing toward deeper spiritual and relationship issues that need to be addressed. Unless you've changed the original dynamics -- the reason why you were depressed -- you will get depressed again."
Life isn't easy, after all. "There are what I would call 'enemies of joy' -- factors in our lives that literally depress us. One of these is the problem of 'mind run rampant,' which causes endless worry. It's a depressing way to live -- so we become depressed," Emmons says. "There is also a feeling of isolation -- that we are going through this life alone. Without the sense that the universe is a friendly place to belong as a family, we have great difficulty not becoming depressed."
Psychologists often turn to cognitive behavioral therapy to help patients change their thought patterns, he notes. "In my own practice, I try to bring in mindfulness practice -- a Buddhist practice -- as another way of addressing mind and thought," he tells WebMD.
Mindfulness involves honing the ability to focus on the present moment, Emmons explains. "It is a way of facing problems we all confront, a way of controlling our thoughts. It's an opportunity to settle the mind so our thoughts aren't so active. Even beyond that, mindfulness gives us a means to work more skillfully with whatever problems we're faced with -- and take them on without feeling overwhelmed. It has an affect on the stresses that fuel depression."
'Circle of Trust'
Rachel was an ideal candidate for mindfulness, says Emmons, because her mind often spun out of control. She took an eight-week mindfulness-based stress reduction class, which can be found in most major cities. She was able to develop an imagery technique to calm her thoughts and fears, he says.
Creating a "circle of trust, a soul community" of like-minded spirits can help us feel less isolated in this very scary world -- another important component of a balanced life, says Emmons. "As much as anything, depression is a call to community, a stark reminder that we cannot go it alone -- we are simply not designed that way," he writes. "In the end, I believe, we need another to heal, and the creation of community is just as important to our well-being as is the inner journey of coming to know ourselves."
Any person facing depression, says Emmons, can emerge from it a larger person. "We can be more than we were before. We need not be diminished or weakened by depression," he tells WebMD.